Abstract
Objective
The study of induced circulatory changes requires simultaneous assessment of multiple regional circulations because of interactions and compensatory mechanisms. Positive end expiratory pressure mechanical ventilation (PEEP) is known to cause marked, and potentially deleterious, cardiovascular changes. Our aim was to use a comprehensive approach to assess PEEP-induced circulatory changes in openvs closed abdomen animals.
Material and methods
In the anesthetized rabbit, we used implantable Doppler micro-probes to measure blood flow simultaneously in the ascending aorta, inferior vena cava, portal vein, hepatic artery, common carotid artery, and renal artery. We studied spontaneously breathing animals (Group A), and open (Group B) and closed abdomen (Group C) animals mechanically ventilated at 0 (ZEEP) and 12 cm H2O PEEP.
Results
In Group A, all biological and hemodynamic variables remained unchanged for three hours at the end of the surgical procedure. In Groups B and C, ZEEP produced no significant hemodynamic change. PEEP induced a decrease in carotid, hepatic, and renal artery blood flow in Groups B and C, a decrease in heart rate and mean arterial blood pressure in Group B, and a decrease in aorta blood flow in Group C.
Conclusions
These experimental results demonstrate the usefulness of the comprehensive approach of circulatory changes, and confirm that PEEP may have deleterious effects on regional blood flow, even without significant change in cardiac output, especially when the abdomen is open.
Résumé
Objectif
L’étude de changements circulatoires induits exige une évaluation simultanée de multiples circulations régionales à cause des interactions et des mécanismes compensateurs. La ventilation mécanique à pression télé-expiratoire positive (PTEP) cause des modifications cardio-vasculaires marquées, potentiellement nocives. Nous évaluons, selon une démarche globale, les changements circulatoires induits par la PTEP dans un abdomen animal ouvert vs fermé.
Méthode
Nous avons utilisé, chez un lapin anesthésié, des microsondes Doppler implantables pour mesurer le débit sanguin simultanément dans l’aorte ascendante, la veine cave inférieure, la veine porte, l’artère hépatique, l’artère carotide commune et l’artère rénale. Nous avons observé les animaux en respiration spontanée (Groupe A), et des animaux à l’abdomen ouvert (Groupe B) ou fermé (Groupe C) sous ventilation mécanique à 0 (ZEP) et 12 cm H2OPTEP.
Résultats
Dans le Groupe A, toutes les variables biologiques et hémodynamiques sont demeurées inchangées pendant trois heures après la fin de l’intervention chirurgicale. Dans les Groupes B et C, la ZEP n’a produit aucun changement hémodynamique significatif. La PTEP a provoqué une baisse du débit sanguin artériel carotide, hépatique et rénal chez les lapins des Groupes B et C, une baisse de la fréquence cardiaque et de la tension artérielle moyenne chez ceux du Groupe B et une baisse du débit sanguin aortique chez ceux du Groupe C.
Conclusion
Ces résultats expérimentaux démontrent l’utilité d’aborder globalement les changements circulatoires et confirment que la PTEP peut provoquer des effets nocifs sur le débit sanguin régional, même sans modification significative du débit cardiaque, surtout lorsque l’abdomen est ouvert.
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Lefrant, JY., Juan, JM., Bruelle, P. et al. Regional blood flows are affected differently by PEEP when the abdomen is open or closed: An experimental rabbit model. Can J Anesth 49, 302–308 (2002). https://doi.org/10.1007/BF03020532
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DOI: https://doi.org/10.1007/BF03020532