Effect of assisted lung ventilation on the level of serum biomarkers of lung injury after robot-assisted surgery: a prospective randomized study

Abstract

INTRODUCTION. It is uncertain whether assisted lung ventilation versus pressure control-volume guaranteed ventilation reduces ventilation-induced pulmonary injury and inflammation during anaesthesia for robotic surgery. OBJECTIVES. To compare Pressure support ventilation Pro (PSVpro) with moderate neuromuscular block (NMB) with protective pressure control-volume guaranteed ventilation (PCV-VG) with intensive neuromuscular block during anaesthesia for robotics abdominal surgery respect to biomarkers levels of lung injury and inflammation. MATERIALS AND METHODS. Design: randomized clinical trial. 35 patients scheduled for elective robotic radical prostatectomy under general anesthesia were randomized into two groups. Group 1 - moderate and shallow NMB (TOF 1-4, TOF ratio T4/T1 < 40 %o) and pressure support ventilation - PSVpro (n = 19), Group 2 - intensive NMB (TOF 0, PTC < 2) and protective pressure control-volume guaranteed ventilation - PCV-VG (n = 16). The primary outcome was the changes in serum levels of inflammation biomarkers (Tumor necrosis factor α (TNF-α), Interleukin-6 (IL-6) and Interleukin-6 (IL-8)) and lung injury biomarker (Surfactant Protein D (SP-D)) 1 hour after the end of surgery. RESULTS. The levels of serum IL-6, IL-8, TNF-α and SP-D, before and after surgery were 2.1 (1.125-16.215), 30.9 (12.85-50.7); 10.6 (8.04-14.75), 13 (8.585-21.25); 4 (4-4.035), 4 (4-4); 66.2 (39.2-91.1), 65.4 (57-109.6) in the Group 1 and 2.20 (1.55-5.33), 26.15 (18.175-42.875); 10.45 (8.6425-16.35), 19.15 (9.77-31.35); 4 (4-4.815), 4 (4-4); 60.65 (49.56-106.73), 63.20 (56.5-106.65) in the Group 2 respectively. Changes in serum biomarkers levels were not significantly different between the two ventilation strategies. CONCLUSIONS. Pressure support ventilation Pro with moderate neuromuscular block compare to protective mandatory lung ventilation with intense neuromuscular block does not affect changes in serum levels of biomarkers for inflammation and lung injury IL-6, IL-8, SP-D and TNF-α in patients undergoing elective robotic prostatectomy.