• Francisco de la Gala, Patricia Piñeiro, Ignacio Garutti, Almudena Reyes, Luis Olmedilla, Patricia Cruz, Patricia Duque, Javier Casanova, Lisa Rancan, Pilar Benito, and Elena Vara.
• From the Department of Anaesthesiology, Gregorio Marañón University General Hospital (FDLA, PP, IG, AR, LO, PC, PD, JC, PB), and Department of Biochemistry and Molecular Biology III, Medical Faculty, Complutense University of Madrid, Madrid, Spain (LR, EV).
• Eur J Anaesthesiol. 2015 Dec 1; 32 (12): 872-80.

BackgroundMeasurement of inflammatory mediators in bronchoalveolar lavage (BAL) during lung resection surgery with periods of one-lung ventilation (OLV) has revealed an intense local pulmonary response. The role of each lung in the inflammation that occurs during this procedure has never been investigated.Objective(S)The primary objective of our study was to compare the inflammatory response in the dependent lung with that of the nondependent lung by measuring inflammatory markers in BAL. Our secondary objective was to assess the behaviour of these inflammatory mediators in patients with and without postoperative pulmonary complications (PPCs).DesignA prospective, observational study.SettingDepartment of Anaesthesiology in a university hospital.PatientsForty-six consecutive patients undergoing lung resection surgery.Intervention(S)BAL samples were taken from dependent and nondependent lung 10 min before initiating OLV and at the end of OLV (once two-lung ventilation was established). All patients were followed up until 30 days after surgery.Main Outcome MeasuresThe concentration of cytokines [interleukin (IL)-1, IL-2, IL-6, IL-10, tumour necrosis factor-alpha (TNF-α)], nitric oxide, carbon monoxide and matrix metalloproteinase 2 (MMP-2) was analysed in both lungs before and after OLV. PPCs were recorded.ResultsIn BAL fluid, all measured biomarkers, apart from IL-10, were significantly greater (P < 0.05) at the end of OLV than those obtained before OLV, both for the dependent and nondependent lung. The increase in measured biomarkers was similar in both lungs. Eight patients developed PPC. Patients who developed PPC had higher levels of TNF-α (P < 0.05) in BAL from the nondependent lung before and after OLV than patients who did not have PPC. Patients who developed PPC had a smaller increase in MMP-2 levels (P < 0.05) in the dependent lung than patients who did not have PPC.ConclusionIn lung resection surgery, the inflammatory response is similar in both lungs. However, the greater increase in TNF-α levels in the nondependent lung and the smaller increase of MMP-2 concentration in the dependent lung may increase the susceptibility to develop PPC.

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