Background. Transthoracic oesophagectomy requires prolonged one-lung ventilation causing
systemic and local inflammatory responses. Application of continuous positive airway
pressure (CPAP) to the collapsed lung potentially reduces pulmonary damage, hypoxia, and
consequent inflammation. This randomized controlled trial studied the influence of CPAP
applied to the collapsed right lung during thoracoscopic oesophagectomy on local and
systemic inflammatory response.
Methods. Broncho-alveolar lavage fluid (BALF) fromthe right collapsedandleft ventilated lung
and serum samples were obtained during surgery from 30 patients undergoing
thoracolaparoscopic oesophagectomy for cancer who were randomized for one-lung
ventilation with or without CPAP applied to the collapsed right lung. Concentrations of
cytokines and chemokines, in BALF and serum, were determined with Luminex.
Results. Patients fromthe control (no CPAP) group had significantly increased concentrations of
interleukin (IL)-1a, IL-1b, IL-10, tumour necrosis factor-alpha, macrophage inflammatory
protein (MIP)-1a, pulmonary and activation-regulated chemokine (PARC), and IL-8 in the
collapsed (right) lung when compared with patients from the CPAP group (P,0.05). The
ventilated (left) lung of the control group showed increased concentrations of monocyte
chemoattractant protein (MCP)-1 and MIP-1a (P,0.05). Serum concentrations of cytokines
and chemokines increased during surgery, but did not differ between the control and CPAP
groups.
Conclusions. A significantly lower local immune response was observed during one-lung
ventilation when CPAP was applied to the collapsed lung. The findings suggest a beneficial
effect of CPAP on the collapsed lung during oesophagectomy with one-lung ventilation