Abstract

Background: Cardio-thoracic surgeries often necessitate the use of one lung ventilation (OLV) to enhance surgical access and visualization. While OLV is standard in these procedures, it poses risks of pulmonary damage due to complex pathophysiological changes, including shunting, ventilation-perfusion mismatch, and reperfusion injury. Monitoring ventilator parameters during thoracic surgery, such as end-tidal carbon dioxide, peak airway pressure, and mechanical power, can provide insights into lung damage. Identifying serum biomarkers, such as IL-8 and surfactant protein D (SP-D), is crucial for early detection of pulmonary damage. IL-8, a pro-inflammatory cytokine, and SP-D, a collectin protein, are potential markers for assessing lung injury. Aim: This study aims to analyze the relationship between OLV procedures and the inflammatory response of IL-8 and serum SP-D levels as lung damage biomarkers in patients undergoing thoracic surgery. Material and Methods: Twenty-eight patients underwent thoracic surgery with one lung ventilation from July to September 2023. All patients were subjected to lung-protective ventilation (LPV) with a tidal volume (VT) of 7 ml/kg predicted body weight (PBW) during two-lung ventilation (TLV) and 5 ml/kg PBW during OLV, with a positive end-expiratory pressure (PEEP) of 5-10 cmH2O. IL-8 and SP-D levels were assessed after intubation (T0), 2 hours after OLV (T1), and 24 hours after surgery (T2). Values for peak pressure, driving pressure, mechanical power and OLV duration were recorded during surgery. Results: Among the 28 patients, 25 subjects (89%) had comorbidities, with lung tumor (11) and tuberculosis (TB) (9) being the most common. Comparative analysis showed differences in IL-8 and SP-D levels during TLV and 2 hours of OLV (P: 0.018 and P: 0.033), with IL-8 and SP-D levels increasing during OLV. IL-8 levels changed from 70.9 (8.9-233.10) to 75.1 (27.4-243.30) ng/L, and SP-D levels changed from 115.9 (35.8-333.2) to 131.1 (64.3-339.3) ng/ml. However, there was no correlation between driving pressure, mechanical power, compliance, OLV duration, and IL-8 and SP-D levels during OLV (P>0.05). Conclusion: IL-8 and SP-D levels increase during OLV in thoracic surgical procedures. The implementation of LPV during OLV can reduce airway pressure during OLV and decrease the release of IL-8 levels even in the post-operative period.

Original languageEnglish
Pages (from-to)374-385
Number of pages12
JournalAfrican Journal of Biological Sciences (South Africa)
Volume6
Issue number4
DOIs
Publication statusPublished - 2024

Keywords

  • Biomarkers of Lung Injury
  • One Lung Ventilation
  • Thoracic Surgery

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