Journal of cardiothoracic and vascular anesthesia · 2026
Two-Lung Ventilation Attenuates Systemic Inflammatory and Oxidative Stress Responses During Thoracic Surgery: A Randomized Clinical Trial.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Ballester Eduardo, Frandoloso Marina, Mendes Ramon Alves, Helene Marcelo Kamimoto, Ballester Maria Eduarda, Effting Pauline Souza, Dominguini Diogo, Ritter Cristiane, Rocco Patricia R M, Dal-Pizzol Felipe
Аннотация
OBJECTIVE: To evaluate whether two-lung ventilation (TLV) attenuates perioperative inflammatory and oxidative responses compared with one-lung ventilation (OLV).
DESIGN: A randomized, open-label clinical trial.
SETTING: Thoracic Surgery Department of a general hospital in Southern Brazil.
PARTICIPANTS: Forty adults (age ≥18 years) undergoing thoracic surgery between July and November 2023 were enrolled. Exclusion criteria included pregnancy, preoperative mechanical ventilation, American Society of Anesthesiologists class IV status, inability to place a double-lumen tube, and prior lung resection.
INTERVENTIONS: Patients were randomized to receive OLV or TLV during surgery.
MEASUREMENTS & MAIN RESULTS: Bronchoalveolar lavage (BAL) fluid from the operated and nonoperated lungs and plasma samples were collected preoperatively and postoperatively. Cytokines (interleukin [IL]-6, IL-1β, IL-8, IL-4, IL-10, and tumor necrosis factor α) and oxidative stress markers (thiobarbituric acid reactive substances, protein carbonyls, and DCFH-DA [2',7'-dichlorodihydrofluorescein diacetate]) were quantified. Group-by-time effects were analyzed using generalized mixed-effects models adjusted for age, sex, and surgical duration. BAL fluid cytokine levels, including the primary outcome, IL-6 (p = 0.57), did not differ between groups. However, TLV was associated with reduced postoperative IL-1β (p = 0.04) and oxidative damage (p = 0.02) in the operated lung. Systemically, TLV markedly attenuated inflammatory and oxidative responses, with lower circulating cytokines and oxidative stress markers and significant group-by-time interactions for multiple mediators.
CONCLUSIONS: Although TLV did not modify local IL-6 concentrations, it consistently dampened systemic inflammatory and oxidative activation induced by thoracic surgery, supporting its potential as a protective perioperative ventilatory strategy.
DESIGN: A randomized, open-label clinical trial.
SETTING: Thoracic Surgery Department of a general hospital in Southern Brazil.
PARTICIPANTS: Forty adults (age ≥18 years) undergoing thoracic surgery between July and November 2023 were enrolled. Exclusion criteria included pregnancy, preoperative mechanical ventilation, American Society of Anesthesiologists class IV status, inability to place a double-lumen tube, and prior lung resection.
INTERVENTIONS: Patients were randomized to receive OLV or TLV during surgery.
MEASUREMENTS & MAIN RESULTS: Bronchoalveolar lavage (BAL) fluid from the operated and nonoperated lungs and plasma samples were collected preoperatively and postoperatively. Cytokines (interleukin [IL]-6, IL-1β, IL-8, IL-4, IL-10, and tumor necrosis factor α) and oxidative stress markers (thiobarbituric acid reactive substances, protein carbonyls, and DCFH-DA [2',7'-dichlorodihydrofluorescein diacetate]) were quantified. Group-by-time effects were analyzed using generalized mixed-effects models adjusted for age, sex, and surgical duration. BAL fluid cytokine levels, including the primary outcome, IL-6 (p = 0.57), did not differ between groups. However, TLV was associated with reduced postoperative IL-1β (p = 0.04) and oxidative damage (p = 0.02) in the operated lung. Systemically, TLV markedly attenuated inflammatory and oxidative responses, with lower circulating cytokines and oxidative stress markers and significant group-by-time interactions for multiple mediators.
CONCLUSIONS: Although TLV did not modify local IL-6 concentrations, it consistently dampened systemic inflammatory and oxidative activation induced by thoracic surgery, supporting its potential as a protective perioperative ventilatory strategy.