Publication: Respuesta inflamatoria local secundaria a la ventilación unipulmonar en un modelo experimental de cirugía torácica. Efecto modulador del sevoflurano
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2016-07-14
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Universidad Complutense de Madrid
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Abstract
El daño pulmonar agudo secundario a la cirugía de resección pulmonar (CRP) afecta en torno al 3-4% de los pacientes sometidos a este procedimiento. A pesar de no resultar una entidad excesivamente frecuente, condiciona en gran medida el pronóstico de los pacientes sometidos a estas técnicas quirúrgicos, resultando la principal causa de mortalidad. En la etiopatogenia de esta entidad clínica intervienen distintos factores como son la ventilación mecánica, la ventilación unipulmonar (OLV), los procesos de isquemia-reperfusión y la manipulación quirúrgica asociada al procedimiento. Estos factores colaboran de forma intercurrente a desencadenar una respuesta inflamatoria secundaria que lesiona el epitelio y endotelio alveolar, ocasionando una alteración de la permeabilidad de la barrera alveolocapilar, y la consiguiente formación de edema en los espacios alveolares. Hace años que se conoce que la ventilación mecánica puede provocar lesiones tisulares y edema pulmonar no cardiogénico en pulmones sanos, derivado de una respuesta inflamatoria secundaria a los distintos estímulos que condiciona la ventilación mecánica. En los procedimientos de CRP, la OLV del pulmón declive (o dependiente) implica una especial agresión al pulmón, con mayor posibilidad de lesión por volumen y presión...
Lung resection surgery (LRS) is still considered as a moderate or high-risk procedure. Respiratory complications are now considered as the main cause of early mortality after LRS and their incidence varies from 3 to 4% with no decrease observed in recent years. Several etiologic factors are involved in the pathogenesis of lung injury. Surgical manipulation of a fragile organ, such as the lung, may result in alterations comparable to pulmonary contusion, which can promote an inflammatory response and cause parenchymal injury. Likewise, one lung ventilation (OLV) originates an adverse stimulus that affects both lungs. The greater airway pressure, higher oxygen concentrations and increased perfusion due to the contralateral hypoxic pulmonary vasoconstriction (HPV) affect the dependent lung during OLV, whereas the nondependent lung undergoes ischemia-reperfusion (I/R) phenomena due to HPV. It has been previously observed that increased levels of pro-inflammatory cytokines (IL-1 and TNF-α) are associated with lung injury in LRS and an early increase in the local production of cytokines has been observed in patients who later developed a clinically relevant acute lung injury (ALI). In both esophagectomy and LRS, the associated inflammatory response is greater than the one observed in other surgical procedures like abdominal surgery...
Lung resection surgery (LRS) is still considered as a moderate or high-risk procedure. Respiratory complications are now considered as the main cause of early mortality after LRS and their incidence varies from 3 to 4% with no decrease observed in recent years. Several etiologic factors are involved in the pathogenesis of lung injury. Surgical manipulation of a fragile organ, such as the lung, may result in alterations comparable to pulmonary contusion, which can promote an inflammatory response and cause parenchymal injury. Likewise, one lung ventilation (OLV) originates an adverse stimulus that affects both lungs. The greater airway pressure, higher oxygen concentrations and increased perfusion due to the contralateral hypoxic pulmonary vasoconstriction (HPV) affect the dependent lung during OLV, whereas the nondependent lung undergoes ischemia-reperfusion (I/R) phenomena due to HPV. It has been previously observed that increased levels of pro-inflammatory cytokines (IL-1 and TNF-α) are associated with lung injury in LRS and an early increase in the local production of cytokines has been observed in patients who later developed a clinically relevant acute lung injury (ALI). In both esophagectomy and LRS, the associated inflammatory response is greater than the one observed in other surgical procedures like abdominal surgery...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 20/10/2015