Indian journal of Medical Biochemistry

Register      Login

VOLUME 21 , ISSUE 1 ( January-June, 2017 ) > List of Articles

ORIGINAL ARTICLE

Systemic Cytokine Response predicts the Outcome of Patients from Mechanical Ventilation

Akila Prashant, Prashant Vishwanath, Nalini Kotekar, Suma M Nataraj, Caroline Kuruvilla, CS Nagalakshmi, Parveen Doddamani

Citation Information : Prashant A, Vishwanath P, Kotekar N, Nataraj SM, Kuruvilla C, Nagalakshmi C, Doddamani P. Systemic Cytokine Response predicts the Outcome of Patients from Mechanical Ventilation. Indian J Med Biochem 2017; 21 (1):5-10.

DOI: 10.5005/jp-journals-10054-0010

License: CC BY 3.0

Published Online: 00-06-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Purpose

Despite the lifesaving potential, mechanical ventilation (MV) imposes a considerable amount of mechanical stress on the lung. Pulmonary and systemic cytokine release due to inflammatory process triggered by MV may give valuable information on patient outcome.

Materials and methods

Thirty patients aged >18 years with acute respiratory distress who required MV were enrolled for the study. Three milliliters of the venous blood was collected immediately after the initiation of MV and at 24 hours. Serum levels of interleukin (IL)-6, IL-8 and, tumor necrosis factor-α (TNF-α) were estimated using quantitative immunometric sandwich enzyme immunoassay technique. Based on their outcome from MV, they were divided into two groups: Survivors (group I) and nonsurvivors (group II).

Results

Serum levels of IL-6 and IL-8 significantly increased in group II (n=13) when compared with group I (n = 17) (p < 0.0001 and p < 0.001 respectively) at 24 hours of MV. However, TNF-α did not show any significant difference between the two groups. The IL-6 >111.9 pg/mL at 24 hours of MV increases the probability of mortality by factor 2.40. An increase of IL-6 by 1 pg/mL significantly increases the relative probability of mortality by a factor of 1.004 (95% CI, 1.0003–1.0078, p = 0.0001).

Conclusion

Estimating the levels of IL-6 and IL-8 at 24 hours of connecting the patient to MV will help in predicting the outcome of the patient.

How to cite this article

Prashant A, Vishwanath P, Kotekar N, Nataraj SM, Kuruvilla C, Nagalakshmi CS, Doddamani P. Systemic Cytokine Response predicts the Outcome of Patients from Mechanical Ventilation. Indian J Med Biochem 2017;21(1):5-10.


PDF Share
  1. Ventilator-induced lung injury. N Engl J Med 2013 Nov;369(22):2126–2136.
  2. Overview of ventilator-induced lung injury mechanisms. Curr Opin Crit Care 2005 Feb;11(1):82–86.
  3. Ventilation-induced lung injury and mechanotransduction: stretching it too far? Am J Physiol Lung Cell Mol Physiol 2002 May;282(5):L892–L896.
  4. Ventilator-induced lung injury: historical perspectives and clinical implications. Ann Intensive Care 2011 Jul;1(1):28.
  5. Mechanical ventilation-induced lung release of cytokines. Anesthesiology 2004 Jul;101:1–3.
  6. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28 day international study. JAMA 2002 Jan;287(3):345–355.
  7. Lower tidal volume ventilation and plasma cytokine markers of inflammation in patients with acute lung injury. Crit Care Med 2005 Jan;33(1):1–6, discussion 23-232.
  8. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000 May;342(18):1301–1308.
  9. Effects of mechanical ventilation on release of cytokines into systemic circulation in patients with normal pulmonary function. Anesthesiology 2000 Dec;93(6):1413–1417.
  10. Production of inflammatory cytokines in ventilator-induced lung injury: a reappraisal. Am J Respir Crit Care Med 2001 Apr;163(5):1176–1180.
  11. Hyperventilation induces release of cytokines from perfused mouse lung. Am J Respir Crit Care Med 1998 Jan;157(1):263–272.
  12. Ventilator-induced lung injury and multiple system organ failure: a critical review of facts and hypotheses. Intensive Care Med 2004 Oct;30(10):1865–1872.
  13. Linking stress to inflammation. Anesthesiol Clin 2006 Jun;24(2):325–340.
  14. Can we make sense out of cytokines? Chest 2000 Apr;117(4):932–934.
  15. Cytokines and biotrauma in ventilator-induced lung injury: a critical review of literature. Neth J Med 2005 Nov;63(10):382–392.
  16. Molecular mechanisms of lung cell activation induced by cyclic stretch. Crit Care Med 2003 Apr;31(Suppl 4):S200–S206.
  17. The role of cytokines during the pathogenesis of ventilator-associated and ventilator-induced lung injury. Semin Respir Crit Care Med 2006 Aug;27(4):350–364.
  18. Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents pulmonary inflammation in patients without preexisting lung injury. Anesthesiology 2008 Jan;108(1):46–54.
  19. Are low tidal volumes safe? Chest 1990 Feb;97(2):430–434.
  20. Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. JAMA 1999 Jul;282(1):54–61.
  21. Intraoperative tidal volume as a risk factor for respiratory failure after pneumonectomy. Anesthesiology 2006 Jul;105(1):14–18.
  22. Protective ventilation influences systemic inflammation after esophagectomy: a randomized controlled study. Anesthesiology 2006 Nov;105(5):911–919.
  23. Patterns of cytokine evolution (tumor necrosis factor-alpha and interleukin-6) after septic shock, hemorrhagic shock, and severe trauma. Crit Care Med 1997 Nov;25(11):1813–1819.
  24. Role of IL-6 and its soluble receptor in induction of chemokines and leukocyte recruitment. Immunity 1997 Mar;6(3):315–325.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.