desmosine and Acute-Lung-Injury

To evaluate the effect of ventilation strategy on markers of inflammation in patients undergoing spine surgery in the prone position.. Randomized controlled trial.. University-affiliated teaching hospital.. 26 ASA physical status 1 and 2 patients scheduled for elective primary lumbar decompression and fusion in the prone position.. Patients were randomized to receive mechanical ventilation with either a tidal volume (V(T)) of 12 mL/kg ideal body weight with zero positive end-expiratory pressure (PEEP) or V(T) of 6 mL/kg ideal body weight with PEEP of 8 cm H(2)O.. Plasma levels of interleukin (IL)-6 and IL-8 were determined at the beginning of ventilation and at 6 and 12 hours later. Urinary levels of desmosine were determined at the beginning of ventilation and on postoperative days 1 and 3.. A significant increase in IL-6, IL-8, and urine desmosine levels was noted over time compared with baseline (P < 0.01). However, no significant difference in the levels of markers was seen between the groups at any time point when controlling for demographics, ASA physical status, body mass index, duration of ventilation, or estimated blood loss.. Although markers of inflammation are increased after posterior spine fusion surgery, ventilation strategy has minimal impact on markers of systemic inflammation.

Topics: Acute Lung Injury; Adult; Aged; Biomarkers; Desmosine; Female; Humans; Inflammation; Inflammation Mediators; Interleukin-6; Interleukin-8; Lumbar Vertebrae; Male; Middle Aged; Positive-Pressure Respiration; Postoperative Complications; Prone Position; Prospective Studies; Spinal Fusion; Tidal Volume

The perioperative inflammatory response as measured by elevated levels of interleukin-6 (IL-6) has been linked to acute respiratory distress syndrome, postoperative confusion, and fever. Because of the extent of surgery,patients undergoing bilateral total knee arthroplasty may be at high risk of complications. We had found a significant decrease in IL-6 in patients having bilateral total knee replacement who received two doses of 100 mg of hydrocortisone eight hours apart; however, by twenty-four hours, IL-6 levels were equal to those in the group that received a placebo. In the present study, we investigated whether the administration of three doses would reduce IL-6 levels at twenty-four hours and affect other outcomes such as desmosine level, a marker of lung injury.. After institutional review board approval, a total of thirty-four patients (seventeen patients and seventeen control subjects) were enrolled in this double-blind, randomized, placebo-controlled study. Three doses of intravenous hydrocortisone (100 mg) or placebo were given eight hours apart. Urinary desmosine levels were obtained at baseline and at one and three days postoperatively. The level of IL-6 was measured at baseline and at six, ten, twenty-four, and forty-eight hours postoperatively. Pain scores, presence of fever, and functional outcomes were recorded.. The level of IL-6 increased in both groups, but was significantly higher in the control group, peaking at twenty-four hours (mean and standard deviation, 623.74 ± 610.35 pg/mL versus 148.13 ± 119.35 pg/mL; p = 0.006). Urinary desmosine levels significantly increased by twenty-four hours in the control group, but remained unchanged in the study group (134.75 ± 67.88 pmol/mg and 79.45 ± 46.30 pmol/mg, respectively; p = 0.006). Pain scores at twenty-four hours were significantly lower in the study group (1.4 ± 0.9 versus 2.4 ± 1.2; p = 0.01) as was the presence of fever (11.8%versus 47.1%; p = 0.03). Range of motion at the knee was significantly greater in the study group (81.6 ± 11.6 versus 70.6 ± 14.0 in the right knee [p = 0.02] and 81.4 ± 11.3 versus 73.4 ± 9.4 in the left knee [p = 0.03]).. Hydrocortisone (100 mg) given over three doses, each eight hours apart, decreased and maintained a lower degree of inflammation with bilateral total knee replacement as measured by IL-6 level. Corticosteroids decreased the prevalence of fever, lowered visual analog pain scores, and improved knee motion. The significantly lower values of desmosine in the study group suggest that this treatment may be protective against lung injury.

Topics: Acute Lung Injury; Aged; Arthroplasty, Replacement, Knee; Biomarkers; Cohort Studies; Cytokines; Desmosine; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Hydrocortisone; Injections, Intravenous; Interleukin-6; Male; Middle Aged; Pain Measurement; Postoperative Complications; Preoperative Care; Prospective Studies; Range of Motion, Articular; Reference Values; Risk Assessment; Time Factors; Treatment Outcome

Topics: Acute Lung Injury; Arthroplasty, Replacement, Knee; Desmosine; Female; Humans; Hydrocortisone; Interleukin-6; Male