Document Detail


Transient hemodynamic effects of recruitment maneuvers in three experimental models of acute lung injury.
MedLine Citation:
PMID:  15599139     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Elevated lung volumes and increased pleural pressures associated with recruitment maneuvers (RM) may adversely affect pulmonary vascular resistance and cardiac filling or performance. We investigated the hemodynamic consequences of three RM techniques after inducing acute lung injury. DESIGN: Prospective, randomized, controlled experimental study. SETTING: Hospital research laboratory. SUBJECTS: Thirteen anesthetized, mechanically ventilated pigs. INTERVENTIONS: We induced three types of acute lung injury: oleic acid injury (n = 4); ventilator-induced lung injury (n = 4); and pneumonia (n = 5). All three models were designed to initiate a similar severity of oxygenation impairment. RM methods tested were sustained inflation, incremental positive end-expiratory pressure (PEEP) with a limited peak pressure, and pressure-controlled ventilation with increased PEEP and a fixed driving pressure. From a baseline PEEP of 8 cm H2O, all interventions were tested using post-RM PEEP levels of 8, 12, and 16 cm H2O. Cardiac output by thermodilution and systemic and pulmonary artery pressures were measured frequently during the RM and for 15 mins after its completion. MEASUREMENTS AND MAIN RESULTS: During the RM, cardiac output decreased to a greater extent in the pneumonia model (0.49 of baseline cardiac output) than in the oleic acid injury (0.67 of baseline) or ventilator-induced lung injury (0.79 of baseline) models. Cardiac output recovered to the baseline value by 5 mins post-RM in oleic acid injury and ventilator-induced lung injury models. However, cardiac output remained decreased 15 mins post-RM in the pneumonia model. There were no differences in hemodynamic parameters among RM methods in oleic acid injury and ventilator-induced lung injury models. In the pneumonia model, however, cardiac output decreased to a greater extent during the RM with sustained inflation (to 0.33 of baseline cardiac output) compared with pressure-controlled ventilation (to 0.68 of baseline). CONCLUSIONS: We conclude that RM transiently but profoundly depressed cardiac output in three models of acute lung injury. The results imply that a lung recruiting maneuver should be used with caution, especially when using sustained inflation in the setting of pneumonia.
Authors:
Sung-Chul Lim; Alexander B Adams; Dana A Simonson; David J Dries; Alain F Broccard; John R Hotchkiss; John J Marini
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Critical care medicine     Volume:  32     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2004 Dec 
Date Detail:
Created Date:  2004-12-15     Completed Date:  2005-01-27     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2378-84     Citation Subset:  AIM; IM    
Affiliation:
Pulmonary/Critical Care Medicine, Regions Hospital/HealthPartners, University of Minnesota, St. Paul, MN 55101, USA.
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Animals
Cardiac Output / physiology*
Disease Models, Animal
Female
Hemodynamics / physiology
Lung Volume Measurements
Male
Oleic Acid
Pneumonia, Pneumococcal
Positive-Pressure Respiration / methods*
Probability
Pulmonary Gas Exchange
Respiration, Artificial
Respiratory Distress Syndrome, Adult / physiopathology,  therapy*
Risk Factors
Sensitivity and Specificity
Swine
Grant Support
ID/Acronym/Agency:
50152//PHS HHS
Chemical
Reg. No./Substance:
112-80-1/Oleic Acid
Comments/Corrections
Comment In:
Crit Care Med. 2004 Dec;32(12):2540-1   [PMID:  15599163 ]

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


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