To the Editor:
Fernandez-Bustamante et al.,1 in their study evaluating the early effects of tidal volume on lung injury biomarkers in surgical patients with healthy lungs, showed that tidal volume (VT) of 6 versus 10 ml/kg did not have any significant effect on inflammatory biomarkers after 60 min of ventilation.
The effect of VT on healthy lungs has always been controversial. Some of the studies having addressed this issue in surgical patients have found no differences in either the lung inflammatory response or outcome between low versus high VT with short ventilatory durations (1 to 3 h)2,3 ; yet, those having suggested that high VT increases proinflammatory mediators have focused on longer ventilatory times.4–6 Furthermore, bronchoalveolar lavage concentrations of proinflammatory biomarkers have been introduced as a more reliable marker of lung injury than plasma levels of these markers.7 Hence, using plasma levels of lung injury biomarkers within 60 min of volutrauma is not an appropriate method for comparing the inflammatory biomarkers concentration. Yet, administration of other techniques rather than plasma levels of biomarkers with longer periods following volutrauma are required to obtain a solid method for the early detection of inflammation following volutrauma.
The authors declare no competing interests.