Abstract
Background
Recruitment manoeuvres are widely used in clinical practice to open the lung and prevent lung injury by derecruitment, although the evidence is still discussed. In this study two different recruitment manoeuvres were compared to no recruitment manoeuvres (control) in ventilated sheep with acute respiratory distress syndrome (ARDS), induced by lung lavage.
Methods
We performed a prospective, randomised study in 26 ventilated sheep with ARDS, to evaluate the effect of two different recruitment manoeuvres on gas exchange, blood pressure and lung injury. The two different recruitment manoeuvres, the high pressure recruitment manoeuvre (HPRM), with high peak pressure, and the smooth and moderate recruitment manoeuvre (SMRM), with lower peak pressure, were compared to controls (no recruitment) after disconnection. Oxygenation index and ventilation efficacy index were calculated to evaluate gas exchange. Lung injury was assessed by inflammatory response in broncho-alveolar lavage fluid (BALF) and blood and histology of the lung.
Results
Oxygenation index improved significantly after both recruitment manoeuvres compared with controls, but no significant difference was found between the recruitment manoeuvres. Blood pressure decreased after HPRM but not after SMRM. HPRM induced a higher number of total cells and more neutrophils in the BALF. In the histology of the lung, mean alveolar size was increased in the dorsocranial region of the lung of SMRM compared to controls.
Conclusion
Recruitment manoeuvres improved oxygenation, but SMRM was superior, with respect to hemodynamics and pulmonary inflammation, in ventilated sheep suffering from ARDS induced by lung lavage.
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References
Oeckler RA, Hubmayr RD (2007) Ventilator-associated lung injury: a search for better therapeutic targets. Eur Respir J 30:11216–11226
Slutsky AS (1999) Lung injury caused by mechanical ventilation. Chest 116:9S–15S
Uhlig U, Uhlig S (2011) Ventilation-induced lung injury. Compr Physiol 1:635–661
Amato MBP, Barbas CSV et al (1998) Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 338:347–354
Brochard L, Roudot-Thoraval F et al (1998) Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. Am J Respir Critical Care Med 158:1831–1838
Stewart TE, Meade MO et al (1998) Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. N Engl J Med 338:355–361
Brower RG, Shanholtz CB et al (1999) Prospective, randomized, controlled clinical trail comparing traditional versus reduced tidal volume ventilation in acute respiratory distress syndrome. Critical Care Med 27(8):1492–1498
The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308
Determann RM, Royakkers A et al (2010) Ventilation with lower tidal volumes compared to conventional tidal volumes for patients without acute lung injury—a preventive randomized controlled trial. Critical Care 14(1):R1
Richard JC, Maggiore SM, Jonson B, Mancebo J, Lemaire F, Brochard L (2001) Influence of tidal volume on alveolar recruitment. Am J Respir Critical Care Med 163:1609–1613
Chu EK, Whitehead T, Slutsky AS (2004) Effects of cyclic opening and closing at low- and high-volume ventilation on bronchoalveolar lavage cytokines. Critical Care Med 32(1):168–174
Halter JM, Steinberg JM et al (2003) Positive end-expiratory pressure after a recruitment maneuver prevents both alveolar collapse and recruitment/derecruitment. Am J Respir Critical Care Med 167:1620–1626
Halbertsma FJ, Vaneker M, van der Hoeven JG (2007) Use of recruitment maneuvers during mechanical ventilation in pediatric and neonatal intensive care units in the Netherlands. Intensive Care Med 33(9):167–1673
Meade MO, Cook DJ et al (2008) Ventilation strategy using low tidal volumes, recruitment maneuvres, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled study. JAMA 299(6):637–645
Hodgson C, Keating JL, Holland AE et al (2009) Recruitment manoeuvres for adults with acute lung injury receiving mechanical ventilation (review). The Cochrane Library, Issue 4
Lapinsky SE, Mehta S (2005) Bench-to-bedside review: recruitment and recruiting maneuvers. Critical Care 9:60–65
Kacmarek RM, Kallet RH (2007) Should recruitment maneuvers be used in the management of ALI and ARDS? Respir Care 52(5):622–631
Van der Kloot TE, Blanch L, Youngblood AM et al (2000) Recruitment maneuvers in three experimental models of acute lung injury. Am J Respir Critical Care Med 161:1485–1494
Borges JB, Okamoto VN et al (2006) Reversibility of lung collapse and hypoxemia in early acute respiratory distress syndrome. Am J Respir Critical Care Med 174:268–278
Povoa P, Almeida E et al (2004) Evaluation of a recruitment maneuver with positive inspiratory pressure and high PEEP in patients with severe ARDS. Acta Anaesthesiol Scand 48:287–293
Moran I, Blanch L et al (2011) Acute physiologic effects of a stepwise recruitment maneuver in acute respiratory distress syndrome. Minerva Anestesiol 77(4):1–9
Odenstedt H, Lindgren S et al (2005) Slow moderate pressure recruitment maneuver minimizes negative circulatory and lung mechanic side effects: evaluation of recruitment maneuvers using electric impedance tomography. Intensive Care Med 31:1706–1714
Fujino Y, Goddon S et al (2001) Repetitive high-pressure recruitment maneuvers required to maximally recruit lung in a sheep model of acute respiratory distress syndrome. Crit Care Med 29(8):1579–1586
Luecke T, Roth H et al (2003) PEEP decreases atelectasis and extra vascular lung water but not lung tissue volume in surfactant-washout lung injury. Intensive Care Med 29:2026–2033
Kramer BW, Moss TJ et al (2001) Dose and time response after intraamniotic endotoxin in preterm lambs. Am J Respir Crit Care Med 164:982–988
Kramer BW, Ladenburger A, Kunzmann et all. (2009) Intravenous lipopolysaccharide-induced pulmonary maturation and structural changes in fetal sheep. Am J Obstet Gynecol 200(2):195.e1–195.e10
Lowry OH, Rosebrough NJ, Farr AL, Randall RJ (1951) Protein measurement with folin phenol reagent. J Biol Chem 193:265–275
Mason RJ, Nellenbogen J, Clements JA (1976) Isolation of disaturated phosphatidylcholine with osmium tetroxide. J Lipid Res 17(3):281–284
Stewart JCM (1980) Colometric determination of phospholipids with ammonium ferrothiocyanate. J Anal Biochem 104:10–14
Been JV, Zoer B, Kloosterboer N et al (2010) Pulmonary vascular endothelial growth factor expression and desaturated phospholipid content in a chicken model of hypoxia-induced fetal growth restriction. Neonatology 97:183–189
The ARDS Clinical Trials Network (2003) Effects of recruitment maneuvers in patients with acute lung injury and acute respiratory distress syndrome ventilated with high positive end-expiratory pressure. Critical Care Med 31(11):2592–2597
Dyhr T, Bonde J, Larsson A (2003) Lung recruitment manoeuvres are effective in regaining lung volume and oxygenation after open endotracheal suctioning in acute respiratory distress syndrome. Critical Care 7:55–62
Fotti G, Cereda M, Sparacino et al (2000) Effects of periodic lung recruitment maneuvres on gas exchange and respiratory mechanics in mechanically ventilated acute respiratory distress syndrome (ARDS) patients. Intensive Care Med 26:501–507
Reiss LK, Kowallik A, Uhlig S (2011) Recurrent recruitment manoeuvres improve lung mechanics and minimize lung injury during mechanical ventilation in healthy mice. PLoS ONE 6(9):e24527
Pinski MR (2005) Cardiovascular issues in respiratory care. Chest 128:592S–597S
Viquerat CE, Righetti A, Suter PM (1983) Biventricular volumes and function in patients with adult respiratory distress syndrome ventilated with PEEP. Chest 83:509–514
Vieillard-Baron A, Loubieres Y, Jl Schmitt et al (1999) Cyclic changes in right ventricular output impedance during mechanical ventilation. J Appl Physiol 87:1644–1650
Gernoth C, Wagner G, Pelosi P, Luecke T (2009) Respiratory and haemodynamic changes during decremental open lung positive end-expiratory pressure titration in patients with acute respiratory distress syndrome. Critical Care 13P:R59
Huh JW, Hong SB, Lim CM, Koh Y (2010) Effect of the alveolar recruitment manoeuvre on haemodynamic parameters in patients with acute respiratory distress syndrome: relationship with oxygenation. Respirology 15:1220–1225
Ranieri VM, Suter PM et al (1999) Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome. JAMA 281(1):54–61
Baker CS, Evans TW, Randle BJ, Haslam PL (1999) Damage to surfactant-specific protein in acute respiratory distress syndrome. Lancet 353:1232–1237
Kramer BW (2007) The respiratory distress syndrome (RDS) in preterm infants—physiology, prophylaxis and new therapeutic approaches. ***Intensivmed 44:403–408
Park WY, Goodman RB et al (2001) Cytokine balance in the lung of patients with acute respiratory distress syndrome. Am J Critical Care Med 164:1898–1903
Lin WC, Lin CF et al (2010) Prediction of outcome in patients with acute respiratory distress syndrome by bronchoalveolar lavage inflammatory mediators. Exp Biol Med (Maywood) 235:57–65
Meier T, Lange A et al (2008) Pulmonary cytokine responses during mechanical ventilation of noninjured lungs with and without end-expiratory pressure. Anesth Analg 107(4):1265–1275
Pelosi P, Rocco PRM, Gama de Abreu M (2011) Use of computed tomography scanning to guide lung recruitment and adjust positive-end expiratory pressure. Curr Opin Critical Care 16
Nieszkowska A, Lu Q et al (2004) Incidence and regional distribution of lung overinflation during mechanical ventilation with positive end-expiratory pressure. Crit Care Med 32(7):1496–1503
Bellardine Black CL, Hoffman AM, Tsai LWl et al (2007) Relationship between dynamic respiratory mechanics and disease heterogeneity in sheep lavage injury. Critical Care Med 35(3):870–878
Bikker IG, Leonhardt S et al (2010) Bedside measurement of changes in lung impedance to monitor alveolar ventilation in dependent and non-dependent parts by electrical impedance tomography during a positive end-expiratory pressure trial in mechanically ventilated intensive care unit patients. Critical Care 14:R100
Frutos-Vivar F, Ferguson ND, Esteban A (2006) Epidemiology of acute lung injury and acute respiratory distress syndrome. Semin Respir Critical Care Med 27(4):327–336
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Engel, M., Nowacki, R.M.E., Reiss, L.K. et al. Comparison of Recruitment Manoeuvres in Ventilated Sheep with Acute Respiratory Distress Syndrome. Lung 191, 77–86 (2013). https://doi.org/10.1007/s00408-012-9428-2
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DOI: https://doi.org/10.1007/s00408-012-9428-2