Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.06.024
Brazilian Journal of Anesthesiology
Original Investigation

Effect of mechanical ventilation during cardiopulmonary bypass on oxidative stress: a randomized clinical trial

Efeito da ventilação mecânica durante a circulação extracorpórea no estresse oxidativo: um ensaio clínico randomizado

Yavuz Orak; Filiz Alkan Baylan; Aydemir Kocaslan; Erdinc Eroglu; Mehmet Acipayam; Mehmet Kirisci; Omer Faruk Boran; Adem Doganer

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Abstract

Background: Cardiopulmonary bypass (CPB) causes systemic oxidative stress response and endothelial damage in systemic organs. We investigated the effects of positive end-expiratory pressure (PEEP) and mechanical ventilation (MV) applications on oxidative stress in CPB.

Methods: Seventy-one patients were recruited and 60 completed the study. Randomized groups: MV off (Group 1); MV on, tidal volume (TV) at 3-4 mL.kg-1 (Group 2); MV on, TV at 3-4 mL.kg-1, PEEP at 5 cmH2O (Group 3), n = 20 in each group. As oxidative stress markers, we used glutathione peroxidase (GPx), total antioxidant status (TAS), total oxidant status (TOS), total and native thiol (TT, NT), malondialdehyde (MDA), and catalase. We also investigated the correlation between oxidative stress and postoperative intubation time.

Results: The postoperative GPx levels in Group 2 were higher than Group 3 (p = 0.017). In groups 2 and 3, TAS levels were higher postoperatively than intraoperatively (p = 0.001, p = 0.019, respectively). In Group 2, the TT levels were higher postoperatively than preoperatively and intraoperatively (p = 0.008). In Group 3, the postoperative MDA levels were higher than preoperatively (p = 0.001) and were higher than both postoperative levels of Group 1 and 2 (p = 0.043, p = 0.003). As the preoperative TAS (Group 2) decreased and the postoperative NT (Group 2) and catalase (Group 3) increased, the postoperative intubation time lengthened.

Conclusion: MV (3-4 mL.kg-1) alone seems to be the most advantageous strategy. Prolonged postoperative intubation time was associated with both increased NT and catalase levels.

Keywords

Oxidative stress, Peep, Tidal volume, Cardiopulmonary bypass

Resumo

Introdução: A circulação extracorpórea (CEC) causa resposta ao estresse oxidativo sistêmico e dano endotelial em órgãos sistêmicos. Nós investigamos os efeitos das aplicações de pressão expiratória final positiva (PEEP) e ventilação mecânica (VM) sobre o estresse oxidativo em CEC.

Métodos: Setenta e um pacientes foram recrutados e 60 completaram o estudo. Grupos randomizados: VM desligada (Grupo 1); VM ligada, volume corrente (VC) de 3 a 4 mL.kg-1 (Grupo 2); VM ligada, TV de 3 a 4 mL.kg-1, PEEP de 5 cmH2O (Grupo 3), n = 20 em cada grupo. Como marcadores de estresse oxidativo, usamos glutationa peroxidase (GPx), estado antioxidante total (EAT), estado oxidante total (TOS), tiol total e nativo (TT, TN), malondialdeído (MDA) e catalase. Também investigamos a correlação entre o estresse oxidativo e o tempo de intubação pós-operatória. 

Resultados: Os níveis de GPx pós-operatório no Grupo 2 foram maiores do que no Grupo 3 (p = 0,017). Nos grupos 2 e 3, os níveis de TAS foram maiores no pós-operatório do que no intraoperatório (p = 0,001, p = 0,019, respectivamente). No Grupo 2, os níveis de TT foram maiores no pós-operatório do que no pré-operatório e intraoperatório (p = 0,008). No Grupo 3, os níveis de MDA pós-operatório foram maiores do que no pré-operatório (p = 0,001) e foram maiores do que ambos os níveis pós-operatórios do Grupo 1 e 2 (p = 0,043, p = 0,003). À medida que a EAT pré-operatória (Grupo 2) diminuiu e a TN pós-operatória (Grupo 2) e a catalase (Grupo 3) aumentaram, o tempo de intubação pós-operatório aumentou. 

Conclusão: A VM (3-4 mL.kg-1) isolada parece ser a estratégia mais vantajosa. O tempo prolongado de intubação pós-operatória foi associado ao aumento dos níveis de TN e catalase.

Palavras-chave

Estresse oxidativo, Peep, Volume corrente, Circulação extracorpórea

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Submitted date:
12/03/2019

Accepted date:
06/26/2021

61080328a95395453947f585 rba Articles

Braz J Anesthesiol

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