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Intensive Care Medicine

, Volume 31, Issue 1, pp 112–120 | Cite as

Acute hemodynamic changes during lung recruitment in lavage and endotoxin-induced ALI

  • Helena OdenstedtEmail author
  • Anders Åneman
  • Sigurbergur Kárason
  • Ola Stenqvist
  • Stefan Lundin
Experimental

Abstract

Objective

To assess acute cardiorespiratory effects of recruitment manoeuvres in experimental acute lung injury.

Design

Experimental study in animal models of acute lung injury.

Setting

Experimental laboratory at a University Medical Centre.

Animals

Ten pigs with bronchoalveolar lavage and eight pigs with endotoxin-induced ALI.

Interventions

Two kinds of recruitment manoeuvres during 1 min; a) vital capacity manoeuvres (ViCM) consisting in a sustained inflation at 30 cmH2O and 40 cmH2O; b) manoeuvres obtained during ongoing pressure-controlled ventilation (PCRM) with peak airway pressure 30 cmH2O, positive end-expiratory pressure (PEEP) 15 and peak airway pressure 40, PEEP 20. Recruitment manoeuvres were repeated after volume expansion (dextran 8 ml/kg). Oxygenation, mean arterial, and pulmonary artery pressures, aortic, mesenteric, and renal blood flow were monitored.

Measurements and results

Lower pressure recruitment manoeuvres (ViCM30 and PCRM30/15) did not significantly improve oxygenation. With ViCM and PCRM at peak airway pressure 40 cmH2O, PaO2 increased to similar levels in both lavage and endotoxin groups. Aortic blood flow was reduced from baseline during PCRM40/20 and ViCM40 by 57±3% and 61±6% in the lavage group and by 57±8% and 82±7% (P<0.05 vs PCRM40/20) in endotoxin group. The decrease in blood pressure was less pronounced. Prior volume expansion attenuated circulatory impairment. After cessation of recruitment hemodynamic parameters were restored within 3 min.

Conclusion

Effective recruitment resulted in systemic hypotension, pulmonary hypertension, and decrease in aortic blood flow especially in endotoxinemic animals. Circulatory depression may be attenuated using recruitment manoeuvres during ongoing pressure-controlled ventilation and by prior volume expansion.

Keywords

Acute lung injury Lung recruitment Bronchoalveolar lavage Endotoxin Hemodynamics Oxygen delivery 

Notes

Acknowledgements

Valuable assistance was provided by laboratory assistant Marita Ahlqvist. The study was supported by grants from the Medical Faculty of Göteborg University, the Swedish Research Council (K2003–04X-14032-03A), and the Göteborg Medical Society.

References

  1. 1.
    Ashbaugh DG, Bigelow DB, Petty TL, Levine BE (1967) Acute respiratory distress in adults. Lancet 2:319–323CrossRefPubMedGoogle Scholar
  2. 2.
    Russell J, Walley K (1999) Overwiew, clinical evaluation and chest radiology of ARDS. Cambridge University, New York, p 6–27Google Scholar
  3. 3.
    Lachmann B (1992) Open up the lung and keep the lung open. Intensive Care Med 18:319–321PubMedGoogle Scholar
  4. 4.
    Rothen HU, Sporre B, Engberg G, Wegenius G, Hedenstierna G (1993) Re-expansion of atelectasis during general anaesthesia: a computed tomography study. Br J Anaesth 71:788–795PubMedGoogle Scholar
  5. 5.
    Grasso S, Mascia L, Del Turco M, Malacarne P, Giunta F, Brochard L, Slutsky AS, Marco Ranieri V (2002) Effects of recruiting maneuvers in patients with acute respiratory distress syndrome ventilated with protective ventilatory strategy. Anesthesiology 96:795–802CrossRefPubMedGoogle Scholar
  6. 6.
    Böhm S, Vazques de Anda G, Lachmann B (1998) The open lung concept. In: Vincent J (ed), Yearbook of intensive care and emergency medicine. Springer, Berlin Heidelberg New York, pp 430–440Google Scholar
  7. 7.
    Pinsky MR (1997) The hemodynamic consequences of mechanical ventilation: an evolving story. Intensive Care Med 23:493–503CrossRefPubMedGoogle Scholar
  8. 8.
    De Backer D (2000) The effects of positive end-expiratory pressure on the splanchnic circulation. Intensive Care Med 26:361–363CrossRefPubMedGoogle Scholar
  9. 9.
    Vieillard-Baron A, Loubieres Y, Schmitt JM, Page B, Dubourg O, Jardin F (1999) Cyclic changes in right ventricular output impedance during mechanical ventilation. J Appl Physiol 87:1644–1650PubMedGoogle Scholar
  10. 10.
    Brienza N, Revelly JP, Ayuse T, Robotham JL (1995) Effects of PEEP on liver arterial and venous blood flows. Am J Respir Crit Care Med 152:504–510PubMedGoogle Scholar
  11. 11.
    Aneman A, Eisenhofer G, Fandriks L, Olbe L, Dalenback J, Nitescu P, Friberg P (1999) Splanchnic circulation and regional sympathetic outflow during peroperative PEEP ventilation in humans. Br J Anaesth 82:838–842PubMedGoogle Scholar
  12. 12.
    Winso O, Biber B, Gustavsson B, Holm C, Milsom I, Niemand D (1986) Portal blood flow in man during graded positive end-expiratory pressure ventilation. Intensive Care Med 12:80–85PubMedGoogle Scholar
  13. 13.
    Priebe HJ, Heimann JC, Hedley-Whyte J (1981) Mechanisms of renal dysfunction during positive end-expiratory pressure ventilation. J Appl Physiol 50:643–649PubMedGoogle Scholar
  14. 14.
    Shinozaki M, Muteki T, Kaku N, Tsuda H (1988) Hemodynamic relationship between renal venous pressure and blood flow regulation during positive end-expiratory pressure. Crit Care Med 16:144–147PubMedGoogle Scholar
  15. 15.
    Mullins RJ, Dawe EJ, Lucas CE, Ledgerwood AM, Banks SM (1984) Mechanisms of impaired renal function with PEEP. J Surg Res 37:189–196CrossRefPubMedGoogle Scholar
  16. 16.
    Farge D, De la Coussaye JE, Beloucif S, Fratacci MD, Payen DM (1995) Interactions between hemodynamic and hormonal modifications during PEEP- induced antidiuresis and antinatriuresis. Chest 107:1095–1100PubMedGoogle Scholar
  17. 17.
    Venus B, Mathru M, Smith RA, Pham CG, Shirakawa Y, Sugiura A (1985) Renal function during application of positive end-expiratory pressure in swine: effects of hydration. Anesthesiology 62:765–769PubMedGoogle Scholar
  18. 18.
    Aneman A, Ponten J, Fandriks L, Eisenhofer G, Friberg P, Biber B (1997) Hemodynamic, sympathetic and angiotensin II responses to PEEP ventilation before and during administration of isoflurane. Acta Anaesthesiol Scand 41:41–48PubMedGoogle Scholar
  19. 19.
    Lachmann B, Robertson B, Vogel J (1980) In vivo lung lavage as an experimental model of the respiratory distress syndrome. Acta Anaesthesiol Scand 24:231–236PubMedGoogle Scholar
  20. 20.
    Nielsen JB, Sjostrand UH, Edgren EL, Lichtwarck-Aschoff M, Svensson BA (1991) An experimental study of different ventilatory modes in piglets in severe respiratory distress induced by surfactant depletion. Intensive Care Med 17:225–233PubMedGoogle Scholar
  21. 21.
    Borg T, Alvfors A, Gerdin B, Modig J (1985) A porcine model of early adult respiratory distress syndrome induced by endotoxaemia. Acta Anaesthesiol Scand 29:814–830PubMedGoogle Scholar
  22. 22.
    Kloot TE, Blanch L, Melynne Youngblood A, Weinert C, Adams AB, Marini JJ, Shapiro RS, Nahum A (2000) Recruitment maneuvers in three experimental models of acute lung injury. Effect on lung volume and gas exchange. Am J Respir Crit Care Med 161:1485–1494PubMedGoogle Scholar
  23. 23.
    Neumann P, Berglund JE, Mondejar EF, Magnusson A, Hedenstierna G (1998) Dynamics of lung collapse and recruitment during prolonged breathing in porcine lung injury. J Appl Physiol 85:1533–1543PubMedGoogle Scholar
  24. 24.
    Gattinoni L, Pelosi P, Suter PM, Pedoto A, Vercesi P, Lissoni A (1998) Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Crit Care Med 158:3–11PubMedGoogle Scholar
  25. 25.
    Ranieri VM, Brienza N, Santostasi S, Puntillo F, Mascia L, Vitale N, Giuliani R, Memeo V, Bruno F, Fiore T, Brienza A, Slutsky AS (1997) Impairment of lung and chest wall mechanics in patients with acute respiratory distress syndrome: role of abdominal distension. Am J Respir Crit Care Med 156:1082–1091PubMedGoogle Scholar
  26. 26.
    Dantzker DR, Lynch JP, Weg JG (1980) Depression of cardiac output is a mechanism of shunt reduction in the therapy of acute respiratory failure. Chest 77:636–642PubMedGoogle Scholar
  27. 27.
    Rothen HU, Sporre B, Engberg G, Wegenius G, Hedenstierna G (1995) Reexpansion of atelectasis during general anaesthesia may have a prolonged effect. Acta Anaesthesiol Scand 39:118–125PubMedGoogle Scholar
  28. 28.
    Lapinsky SE, Aubin M, Mehta S, Boiteau P, Slutsky AS (1999) Safety and efficacy of a sustained inflation for alveolar recruitment in adults with respiratory failure. Intensive Care Med 25:1297–1301PubMedGoogle Scholar
  29. 29.
    Fujino Y, Goddon S, Dolhnikoff M, Hess D, Amato MB, Kacmarek RM (2001) Repetitive high-pressure recruitment maneuvers required to maximally recruit lung in a sheep model of acute respiratory distress syndrome. Crit Care Med 29:1579–1586CrossRefPubMedGoogle Scholar
  30. 30.
    Villagra A, Ochagavia A, Vatua S, Murias G, Del Mar Fernandez M, Lopez Aguilar J, Fernandez R, Blanch L (2002) Recruitment maneuvers during lung protective ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med 165:165–170PubMedGoogle Scholar
  31. 31.
    Carvalho CR, Barbas CS, Medeiros DM, Magaldi RB, Lorenzi Filho G, Kairalla RA, Deheinzelin D, Munhoz C, Kaufmann M, Ferreira M, Takagaki TY, Amato MB (1997) Temporal hemodynamic effects of permissive hypercapnia associated with ideal PEEP in ARDS. Am J Respir Crit Care Med 156:1458–1466PubMedGoogle Scholar
  32. 32.
    Thorens JB, Jolliet P, Ritz M, Chevrolet JC (1996) Effects of rapid permissive hypercapnia on hemodynamics, gas exchange, and oxygen transport and consumption during mechanical ventilation for the acute respiratory distress syndrome. Intensive Care Med 22:182–191PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Helena Odenstedt
    • 1
    Email author
  • Anders Åneman
    • 1
  • Sigurbergur Kárason
    • 2
  • Ola Stenqvist
    • 1
  • Stefan Lundin
    • 1
  1. 1.Department of Anaesthesia and Intensive CareSahlgrenska University HospitalGöteborgSweden
  2. 2.Department of Anaesthesia and Intensive CareLandspitali University HospitalReykjavikIceland

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