Hemodynamic effects of different lung-protective ventilation strategies in closed-chest pigs with normal lungs

被引:33
作者
Roosens, Carl D. [1 ]
Ama, Ruggero
Leather, H. Alex
Segers, Patrick
Sorbara, Carlo
Wouters, Patrick F.
Poelaert, Jan I.
机构
[1] Ghent Univ Hosp, Dept Intens Care, B-9000 Ghent, Belgium
[2] Catholic Univ Louvain, Dept Anesthesiol, B-3000 Louvain, Belgium
[3] Univ Ghent, Hydraul Lab, Cardiovasc Mech & Biofluid Res Unit, B-9000 Ghent, Belgium
[4] Univ Ghent, Int Res Ctr, B-9000 Ghent, Belgium
[5] Careggi Univ Hosp, Dept Anesthesiol & Intens Care, Florence, Italy
关键词
lung-protective ventilation; hemodynamics; pig; high-frequency oscillation;
D O I
10.1097/01.CCM.0000242758.37427.16
中图分类号
R4 [临床医学];
学科分类号
1002 [临床医学]; 100602 [中西医结合临床];
摘要
Objective: The benefits of lung-protective ventilation strategies used for acute respiratory distress syndrome in subjects with normal lungs are uncertain. The purpose of this study was to investigate the hemodynamic effects of conventional lung-protective ventilation (CLPV) and high-frequency oscillatory ventilation (HFOV) in a normal lung animal model. Design: Prospective laboratory investigation. Setting. Animal laboratory in a university medical center. Subjects. Seven landrace pigs (mean weight 41 kg). Interventions: Pigs were ventilated at random conventionally with positive end-expiratory pressure 2-3 cm H2O and tidal volume 10-12 mL/kg (control), with CLPV (positive end-expiratory pressure 10 cm H2O, tidal volume 6 mL/kg), or with HFOV. Hemodynamics were analyzed after insertion of biventricular conductance catheters and a pulmonary artery catheter. Measurements and Main Results: The protective strategies led to higher mean airway pressures and severe hypercapnia with acidosis, which was only significant with CLPV. Compared with control, oxygenation was worse with CLPV and HFOV. With HFOV and CLPV, mean arterial pressure, cardiac output, and stroke volume decreased significantly; pulmonary arterial elastance increased. The slope of the end-diastolic pressure volume relationship for the left and right ventricle remained unchanged (preserved ventricular function), whereas the intercept increased with both protective strategies (augmented intrathoracic pressure); left and right end-diastolic volumes decreased significantly. Conclusions. In the absence of a fluid resuscitation strategy, CLPV and HFOV caused decreased mean arterial pressure, cardiac output, and stroke volume and worsened oxygenation in this normal lung animal model. This resulted primarily from a biventricular decrease in preload.
引用
收藏
页码:2990 / 2996
页数:7
相关论文
共 46 条
[1]
*AC RESP DISTR SYN, 2000, NEW ENGL J MED, V342, P1301, DOI DOI 10.1056/NEJM200005043421801
[2]
BENEFICIAL-EFFECTS OF THE OPEN LUNG APPROACH WITH LOW DISTENDING PRESSURES IN ACUTE RESPIRATORY-DISTRESS SYNDROME - A PROSPECTIVE RANDOMIZED STUDY ON MECHANICAL VENTILATION [J].
AMATO, MBP ;
BARBAS, CSV ;
MEDEIROS, DM ;
SCHETTINO, GDPP ;
LORENZI, G ;
KAIRALLA, RA ;
DEHEINZELIN, D ;
MORAIS, C ;
FERNANDES, EDO ;
TAKAGAKI, TY ;
DECARVALHO, CRR .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1995, 152 (06) :1835-1846
[3]
Validation of right and left ventricular conductance and echocardiography for cardiac function studies [J].
Amirhamzeh, MMR ;
Dean, DA ;
Jia, CX ;
Cabreriza, SE ;
Yano, OJ ;
Burkhoff, D ;
Spotnitz, HM .
ANNALS OF THORACIC SURGERY, 1996, 62 (04) :1104-1109
[4]
Temporal hemodynamic effects of permissive hypercapnia as associated with ideal PEEP in ARDS [J].
Carvalho, CRR ;
Barbas, CSV ;
Medeiros, DM ;
Magaldi, RB ;
Lorenzi, G ;
Kairalla, RA ;
Deheinzelin, D ;
Munhoz, C ;
Kaufmann, M ;
Ferreira, M ;
Takagaki, TY ;
Amato, MBP .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1997, 156 (05) :1458-1466
[5]
Increasing tidal volumes and pulmonary overdistention adversely affect pulmonary vascular mechanics and cardiac output in a pediatric swine model [J].
Cheifetz, IM ;
Craig, DM ;
Quick, G ;
McGovern, JJ ;
Cannon, ML ;
Ungerleider, RM ;
Smith, PK ;
Meliones, JN .
CRITICAL CARE MEDICINE, 1998, 26 (04) :710-716
[6]
Acute effects of tidal volume strategy on hemodynamics, fluid balance, and sedation in acute lung injury [J].
Cheng, IW ;
Eisner, MD ;
Thompson, BT ;
Ware, LB ;
Matthay, MA .
CRITICAL CARE MEDICINE, 2005, 33 (01) :63-70
[7]
PROSPECTIVE, RANDOMIZED COMPARISON OF HIGH-FREQUENCY OSCILLATION AND CONVENTIONAL VENTILATION IN CANDIDATES FOR EXTRACORPOREAL MEMBRANE-OXYGENATION [J].
CLARK, RH ;
YODER, BA ;
SELL, MS .
JOURNAL OF PEDIATRICS, 1994, 124 (03) :447-454
[8]
ADVERSE-EFFECTS OF LARGE TIDAL VOLUME AND LOW PEEP IN CANINE ACID ASPIRATION [J].
CORBRIDGE, TC ;
WOOD, LDH ;
CRAWFORD, GP ;
CHUDOBA, MJ ;
YANOS, J ;
SZNAJDER, JI .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1990, 142 (02) :311-315
[9]
High-frequency oscillatory ventilation versus conventional mechanical ventilation for very-low-birth-weight infants [J].
Courtney, SE ;
Durand, DJ ;
Asselin, JM ;
Hudak, ML ;
Aschner, JL ;
Shoemaker, CT .
NEW ENGLAND JOURNAL OF MEDICINE, 2002, 347 (09) :643-652
[10]
Right ventricular volume measurement by conductance catheter [J].
Danton, MHD ;
Greil, GF ;
Byrne, JG ;
Hsin, M ;
Cohn, L ;
Maier, SE .
AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY, 2003, 285 (04) :H1774-H1785