Effect of different ventilatory strategies on local and systemic cytokine production in intact swine lungs in vivo

The purpose of the study was to investigate the effect of different ventilatory strategies on local and systemic cytokine production in swine with intact lungs in vivo after 4 h of mechanical ventilation. Twenty-five swine were anesthetized and then randomized into five groups (n = 5): (1) low tidal volume zero PEEP (LVZP); (2) medium tidal volume zero PEEP (MVZP); (3) high tidal volume zero PEEP (HVZP); (4) low tidal volume PEEP (LVP); (4) high tidal volume PEEP (HVP). Respiratory rate was adjusted to maintain normocapnia and fraction of inspired oxygen (FiO2) was 1.0. TNF-α and IL-10 were measured in BALF and serum at baseline, 2 h, and 4 h of MV. One animal in LVZP (2 h) and two in HVP (3 h) group died before the end of the experiment. TNF-α level in BALF was significantly higher in LVZP and LVP at 4 h compared to baseline and the other groups. IL-10 level in BALF was significantly higher in LVP at 4 h compared to baseline and the other groups. There was a statistically significant increase in serum TNF-α levels at 4 h in LVP group compared to baseline and the other groups at 4 h. There was statistically significant increase in serum IL-10 levels in HVZP and LVP groups at 2 and 4 h which was significantly higher compared to the other groups at 4 h. Our results show that a) low volume MV may induce local and systemic pro- and anti-inflammatory cytokine increase b) in the presence of pro-inflammatory cytokine response there is also an anti-inflammatory response in the same compartment (lungs, circulation). c) There maybe loss of alveolar-to-systemic cytokine compartmentalization. © 2006 Elsevier Inc. All rights reserved

Diagnostic coronary angiography is related to decreased TNF-α production after ex-vivo whole blood stimulation with LPS

Background: Several studies showed serum markers elevation as a result to coronary angiography. We investigated the effect of diagnostic coronary angiography (DCA) on the development of systemic inflammatory response syndrome (SIRS) and on whole blood cytokine production capacity after ex-vivo LPS stimulation. Methods: In this observational study, clinical characteristics and serum cytokines of the patients were recorded at baseline and at 2, 6, 12, and 24. h after DCA. Peripheral blood was collected at baseline and at 2, and 24. h for complete blood count, coagulation profile and ex-vivo (100 μl) stimulation with LPS (500. pg) for subsequent cytokine measurement. Values are expressed as median ± IQR and were compared using Wilcoxon's signed rank test with Bonferroni adjustment. Results: We included 23 male patients (mean age 52.0 ± 18.0 years) undergoing DCA. None of the patients developed clinical or laboratory signs of SIRS. Serum IL-6 significantly increased at 12. h. There was a significant decrease in TNF-α production after ex-vivo LPS stimulation of whole blood at 2 and 24. h compared to baseline (median ± IQR; 716.0 ± 319.0; 576.0 ± 715.0 vs 1154 ± 844.0 pg/ml; respectively) suggesting that DCA may cause transient endotoxin tolerance. Conclusions: DCA is related to increased serum IL-6 levels but does not cause clinical SIRS. Development of SIRS after DCA is indicative of other in origin complication. DCA is associated with immune cells hyporesponsiveness, possibly through monocyte depression, expressed as decreased TNF-α production after whole blood stimulation with LPS ex vivo. © 2010 Elsevier Ltd