Document Detail

Hemodynamic effects of PEEP in a porcine model of HCl-induced mild acute lung injury.
MedLine Citation:
PMID:  19094174     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Positive end-expiratory pressure (PEEP) and sustained inspiratory insufflations (SI) during acute lung injury (ALI) are suggested to improve oxygenation and respiratory mechanics. We aimed to investigate the hemodynamic effects of PEEP with and without alveolar recruiting maneuver in a mild ALI model induced by inhalation of hydrochloric acid. METHODS: Thirty-two pigs were randomly allocated into four groups (Control-PEEP, Control-SI, ALI-PEEP and ALI-SI). ALI was induced by intratracheal instillation of hydrochloric acid. PEEP values were progressively increased and decreased from 5, 10, 15 and 20 cmH2O in all groups. Three SIs maneuvers of 30 cmH2O for 20 s were applied to the assignable groups between each PEEP level. Transesophageal echocardiography (TEE), global hemodynamics, oxygenation indexes and gastric tonometry were measured 5 min after the maneuvers had been concluded and at each established value of PEEP (5, 10, 15 and 20 cmH2O). RESULTS: The cardiac index, ejection fraction and end-diastolic volume of right ventricle were significantly (P < 0.001) decreased with PEEP in both Control and ALI groups. Left ventricle echocardiography showed a significant decrease in end-diastolic volume at 20 cmH2O of PEEP (P < 0.001). SIs did not exert any significant hemodynamic effects either early (after 5 min) or late (after 3 h). CONCLUSIONS: In a mild ALI model induced by inhalation of hydrochloric acid, significant hemodynamic impairment characterized by cardiac function deterioration occurred during PEEP increment, but SI, probably due to low applied values (30 cmH2O), did not exert further negative hemodynamic effects. PEEP should be used cautiously in ALI caused by acid gastric content inhalation.
C K Marumo; D A Otsuki; D T Fantoni; C B Margarido; A M Ambrósio; P Pelosi; J O C Auler
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-12-15
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  53     ISSN:  1399-6576     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-01-29     Completed Date:  2009-03-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  England    
Other Details:
Languages:  eng     Pagination:  190-202     Citation Subset:  IM    
Laboratory of Medical Investigation LIM08, Faculdade de Medicina, Universidade de São Paulo, Brazil.
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MeSH Terms
Acute Lung Injury / blood,  chemically induced,  pathology,  physiopathology,  therapy*
Disease Models, Animal
Echocardiography, Transesophageal
Hydrochloric Acid / toxicity
Lung / pathology
Lung Compliance
Oxygen / blood
Partial Pressure
Positive-Pressure Respiration*
Random Allocation
Respiratory Aspiration
Single-Blind Method
Stroke Volume
Sus scrofa
Vascular Resistance
Reg. No./Substance:
7647-01-0/Hydrochloric Acid; 7782-44-7/Oxygen

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