Document Detail


Slow moderate pressure recruitment maneuver minimizes negative circulatory and lung mechanic side effects: evaluation of recruitment maneuvers using electric impedance tomography.
MedLine Citation:
PMID:  16177920     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the efficacy of different lung recruitment maneuvers using electric impedance tomography. DESIGN AND SETTING: Experimental study in animal model of acute lung injury in an animal research laboratory. SUBJECTS: Fourteen pigs with saline lavage induced lung injury. INTERVENTIONS: Lung volume, regional ventilation distribution, gas exchange, and hemodynamics were monitored during three different recruitment procedures: (a) vital capacity maneuver to an inspiratory pressure of 40 cmH2O (ViCM), (b) pressure-controlled recruitment maneuver with peak pressure 40 and PEEP 20 cmH2O, both maneuvers repeated three times for 30 s (PCRM), and (c) a slow recruitment with PEEP elevation to 15 cmH2O with end inspiratory pauses for 7 s twice per minute over 15 min (SLRM). MEASUREMENTS AND RESULTS: Improvement in lung volume, compliance, and gas exchange were similar in all three procedures 15 min after recruitment. Ventilation in dorsal regions of the lungs increased by 60% as a result of increased regional compliance. During PCRM compliance decreased by 50% in the ventral region. Cardiac output decreased by 63+/-4% during ViCM, 44+/-2% during PCRM, and 21+/-3% during SLRM. CONCLUSIONS: In a lavage model of acute lung injury alveolar recruitment can be achieved with a slow lower pressure recruitment maneuver with less circulatory depression and negative lung mechanic side effects than with higher pressure recruitment maneuvers. With electric impedance tomography it was possible to monitor lung volume changes continuously.
Authors:
Helena Odenstedt; Sophie Lindgren; Cecilia Oleg?rd; Karin Erlandsson; Sven Lethvall; Anders Aneman; Ola Stenqvist; Stefan Lundin
Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't     Date:  2005-09-22
Journal Detail:
Title:  Intensive care medicine     Volume:  31     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-12-05     Completed Date:  2006-03-17     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1706-14     Citation Subset:  IM    
Affiliation:
Department of Anesthesia and Intensive Care, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden. helena.odenstedt@vgregion.se
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Animals
Electric Impedance*
Hemodynamics
Lung Compliance
Lung Volume Measurements / instrumentation*
Positive-Pressure Respiration / methods*
Pulmonary Atelectasis / prevention & control
Pulmonary Gas Exchange
Pulmonary Ventilation
Random Allocation
Respiratory Distress Syndrome, Adult / diagnosis,  therapy*
Swine
Tomography / methods*
Comments/Corrections
Comment In:
Intensive Care Med. 2005 Dec;31(12):1603-4   [PMID:  16177919 ]

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


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