Pre- and Posttreatment with Hydrogen Sulfide could Improve Perioperative Management by Limiting Ventilator-Induced Lung Injury

Objectives: During and after cardiac surgery, patients are mechanically ventilated. Moreover in complex cardiac surgery procedures, mechanical ventilation can be prolonged and hereby lead to ventilator-induced lung injury. Searching for protection from ventilator-induced lung injury, we examined the effects of hydrogen sulfide. Our hypothesis was that hydrogen sulfide can protect from ventilator-induced lung injury due to its anti-inflammatory and antioxidative effects.

Methods: This study was aimed to determine whether pre- or posttreatment with hydrogen sulfide reduces ventilator-induced lung injury in mice were ventilated with a tidal volume of 12 mL/kg for 6 hours. Pretreated mice inhaled hydrogen sulfide in low dose for 1, 3, or 5 hours prior to mechanical ventilation. Posttreated mice were ventilated with air followed by ventilation with hydrogen sulfide in various combinations. In addition, mice were ventilated with air for 10 hours, or with air for 5 hours and subsequently with hydrogen sulfide for 5 hours. To assess the effects of hydrogen sulfide on ventilator-induced lung injury, lung histology was examined, interleukin-1&β, neutrophil counts, reactive oxygen species formation, and glutathione levels were measured.

Result: We found time dependently reduced histological damage, diminished neutrophil influx, and oxidative stress levels in mice treated with hydrogen sulfide. Even after total ventilation time of 10 hours, lungs showed no histological damage and clearly reduced oxidative stress levels when posttreated with hydrogen sulfide.

Conclusion: Pre- and posttreatment with hydrogen sulfide can protect from ventilator-induced lung injury by reducing inflammation and oxidative stress and could therefore improve perioperative management in complex cardiac surgery.