Document Detail


Recruitment maneuvers in three experimental models of acute lung injury. Effect on lung volume and gas exchange.
MedLine Citation:
PMID:  10806143     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Recruitment maneuvers (RM), consisting of sustained inflations at high airway pressures, have been advocated as an adjunct to mechanical ventilation in acute respiratory distress syndrome (ARDS). We studied the effect of baseline ventilatory strategy and RM on end-expiratory lung volume (EELV) and oxygenation in 18 dogs, using three models of acute lung injury (ALI; n = 6 in each group): saline lavage (LAV), oleic acid injury (OAI), and intratracheal instillation of Escherichia coli (pneumonia; PNM). All three models exhibited similar degrees of lung injury. The PNM model was less responsive to positive end-expiratory pressure (PEEP) than was the LAV or OAI model. Only the LAV model showed an oxygenation response to increasing tidal volume (VT). After RM, there were transient increases in Pa(O(2)) and EELV when ventilating with PEEP = 10 cm H(2)O. At PEEP = 20 cm H(2)O the lungs were probably fully recruited, since the plateau airway pressures were relatively high ( approximately 45 cm H(2)O) and the oxygenation was similar to preinjury values, thus making the system unresponsive to RM. Sustained improvement in oxygenation after RM was seen in the LAV model when ventilating with PEEP = 10 cm H(2)O and VT = 15 ml/kg. Changes in EELV correlated with changes in Pa(O(2)) only in the OAI model with PEEP = 10 cm H(2)O. We conclude that responses to PEEP, VT, and RM differ among these models of ALI. RM may have a role in some patients with ARDS who are ventilated with low PEEP and low VT.
Authors:
T E Kloot; L Blanch; A Melynne Youngblood; C Weinert; A B Adams; J J Marini; R S Shapiro; A Nahum
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  161     ISSN:  1073-449X     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2000 May 
Date Detail:
Created Date:  2000-06-21     Completed Date:  2000-06-21     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1485-94     Citation Subset:  AIM; IM; X    
Affiliation:
Department of Pulmonary and Critical Care Medicine, University of Minnesota, Regions Hospital, St. Paul, Minnesota, USA.
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MeSH Terms
Descriptor/Qualifier:
Animals
Disease Models, Animal*
Dogs
Functional Residual Capacity
Hemodynamics
Lung Volume Measurements*
Oleic Acid
Oxygen / blood
Pneumonia, Bacterial
Positive-Pressure Respiration / methods*
Pulmonary Gas Exchange*
Respiration, Artificial
Respiratory Distress Syndrome, Adult / etiology,  physiopathology*,  therapy
Sodium Chloride
Tidal Volume
Grant Support
ID/Acronym/Agency:
HL-50152/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
112-80-1/Oleic Acid; 7647-14-5/Sodium Chloride; 7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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