The impact of spontaneous ventilation on non-operative lung injury in thoracic surgery: a randomized controlled rabbit model study

Jun Liu; Yuan Zeng; Fei Cui; Yidong Wang; Ping He; Lan Lan; Shaojuan Chen; Wei Wang; Jingpei Li; Jianxing He

doi:10.1093/ejcts/ezx187

The impact of spontaneous ventilation on non-operative lung injury in thoracic surgery: a randomized controlled rabbit model study

Eur J Cardiothorac Surg. 2017 Dec 1;52(6):1083-1089. doi: 10.1093/ejcts/ezx187.

Authors

Jun Liu^{1

2}, Yuan Zeng^{1

2}, Fei Cui^{1

2}, Yidong Wang³, Ping He⁴, Lan Lan⁵, Shaojuan Chen⁵, Wei Wang^{1

2}, Jingpei Li^{1

2}, Jianxing He^{1

2}

Affiliations

¹ Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
² Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, Guangdong, China.
³ Department of Operating Room, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
⁴ Department of Pathology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
⁵ Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.

PMID: 29106495
DOI: 10.1093/ejcts/ezx187

Abstract

Objectives: One-lung ventilation (OLV) with general anaesthesia may increase adverse effects after thoracic surgery, specifically ventilator-induced lung injury. Spontaneous ventilation (SV) has no mechanical ventilation process, thus, we established a rabbit model to assess non-operative lung injury between OLV and SV.

Methods: Thirty-six rabbits were randomly divided into 6 groups: OLV and SV (0, 2 and 4 h). Blood gas analysis was performed after thoracic surgery. Lung tissue and bronchoalveolar lavage fluid were obtained from the non-operative lung. Pathological injury score in lung tissue and tumour necrosis factor α (TNF-α) level in bronchoalveolar lavage fluid using enzyme-linked immunosorbent assay were determined. Moreover, messenger RNA and protein of TNF-α in lung tissue were also determined by quantitative reverse transcriptase polymerase chain reaction and immunohistochemistry.

Results: Compared with the OLV group, significantly higher partial pressure of carbon dioxide (47.78 ± 3.57 vs 38.95 ± 3.88 mmHg, P < 0.01) and partial pressure of oxygen (101.08 ± 13.1 vs 85.6 ± 11.07 mmHg, P < 0.01), as well as a significantly lower pathological injury score (6.83 ± 1.17 vs 8.83 ± 1.72, P < 0.05), TNF-α level in bronchoalveolar lavage fluid (290.32 ± 29.38 vs 368.43 ± 31.26 pg/ml, P < 0.01), TNF-α messenger RNA (6.31 ± 1.13 vs 8.6 ± 1.34, P < 0.01), immunostaining intensity in lung tissue were found at 4 h in the SV group. However, there are no significant differences between OLV and SV groups at 2 h (P > 0.05), except in TNF-α messenger RNA.

Conclusions: Based on this rabbit model, SV for thoracic surgery is not inferior to OLV in terms of lung injury. Considering our results, when performing time-consuming thoracic procedures under OLV, surgeons should more closely examine patients for non-operative lung injury postoperatively.

Keywords: Lung injury; One-lung ventilation; Spontaneous ventilation; Thoracic surgery.

MeSH terms

Animals
Biopsy
Bronchoalveolar Lavage Fluid / chemistry
Cytokines / metabolism
Disease Models, Animal
Lung / metabolism
Lung / pathology
One-Lung Ventilation / adverse effects*
Oxygen / metabolism
Rabbits
Thoracic Surgical Procedures*
Ventilator-Induced Lung Injury / diagnosis
Ventilator-Induced Lung Injury / etiology*
Ventilator-Induced Lung Injury / metabolism

Substances

Cytokines
Oxygen