The sitting position during neurosurgical procedures does not influence serum biomarkers of pulmonary parenchymal injury

The study included patients undergoing planned neurosurgical operations, who were divided into two groups: the sitting group (40 patients, operated on in the sitting position) and the supine group (24 patients, operated in the supine position). After the operation blood samples were drawn, centrifuged, frozen and stored until analyses were conducted. The determination of the SP-D and CC16 levels was performed using an ELISA test. Air embolism (VAE) was defined as a sudden drop in etCO2 of more than 2 mmHg and the presence of air bubbles in the aspirated blood from the central cannula. In all patients, the number of hospitalization days in the postoperative period was calculated.There were no differences in the average levels of SP-D between the groups (the mean in the sitting group was 95.56 ng/mL and the mean in the supine group was 101.21 ng/mL). The average levels of CC16 were similar in both groups as well (6.56ng/mL in the sitting group and 6.79ng/mL in the supine group). There was a statistically significant positive correlation between SP-D and CC16 values in both groups. VAE was diagnosed clinically in 12.5% of cases in the sitting group without a significant increase in SP-D and CC16 levels. On average, patients in both groups were discharged from the hospital within 9 days of surgery.The sitting position and intraoperative VAE during neurosurgical procedures do not affect the concentration of plasma biomarkers of pulmonary parenchymal injury such as SP-D and CC16.In 1821, Magendie published the first report of intra-operative pulmonary air embolism. The case occurred during a procedure to remove a tumor from the neck carried out in the sitting position. The patient did not survive the operation [1]. Since then the challenges and potential complications of the sitting position in neurosurgery have been widely discussed, especially with regard to intraoperative air embolism [2-5].Placing the patient in the sitting position during neurosurgical procedures whe