Low tidal volume ventilation with low PEEP during surgery may induce lung inflammation

BMC Anesthesiol. 2016 Jul 30;16(1):47. doi: 10.1186/s12871-016-0209-y.


Background: Compared to conventional tidal volume ventilation, low tidal-volume ventilation reduces mortality in cased of acute respiratory distress syndrome. The aim of the present study is to determine whether low tidal-volume ventilation reduces the production of inflammatory mediators in the lungs and improves physiological status during hepatic surgery.

Methods: We randomly assigned patients undergoing hepatectomy into 2 groups: conventional tidal-volume vs. low tidal-volume (12 vs. 6 mL•kg(-1) ideal body weight) ventilation with a positive end-expiratory pressure of 3 cm H2O. Arterial blood and airway epithelial lining fluid were sampled immediately after intubation and every 3 h thereafter.

Results: Twenty-five patients were analyzed. No significant changes were found in hemodynamics or acid-base status during the study. Interleukin-8 was significantly elevated in epithelial lining fluid from the low tidal-volume group. Oxygenation evaluated immediately after admission to the post-surgical care unit was significantly worse in the low tidal-volume group.

Conclusions: Low tidal-volume ventilation with low positive end-expiratory pressure may lead to pulmonary inflammation during major surgery such as hepatectomy.

Trial registration: The effect of ventilatory tidal volume on lung injury during hepatectomy that requires transient liver blood flow interruption. UMIN000021371 (03/07/2016); retrospectively registered.

Keywords: Cytokines; Hepatectomy; Micro-sampling Method; Systemic Inflammatory Response Syndrome; Ventilator-Induced Lung Injury.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acid-Base Equilibrium
  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Gas Analysis
  • Female
  • Hemodynamics
  • Humans
  • Interleukin-8 / blood
  • Liver / surgery
  • Male
  • Middle Aged
  • Oxygen / blood
  • Pneumonia / blood*
  • Positive-Pressure Respiration / adverse effects*
  • Postoperative Complications / blood
  • Respiration, Artificial / adverse effects*
  • Tidal Volume / physiology*
  • Young Adult


  • Interleukin-8
  • Oxygen

Associated data

  • JPRN/UMIN000021371