Slow moderate pressure recruitment maneuver minimizes negative circulatory and lung mechanic side effects: evaluation of recruitment maneuvers using electric impedance tomography
- 22 September 2005
- journal article
- research article
- Published by Springer Science and Business Media LLC in Intensive Care Medicine
- Vol. 31 (12), 1706-1714
- https://doi.org/10.1007/s00134-005-2799-6
Abstract
To evaluate the efficacy of different lung recruitment maneuvers using electric impedance tomography. Experimental study in animal model of acute lung injury in an animal research laboratory. Fourteen pigs with saline lavage induced lung injury. 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). 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. 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.Keywords
This publication has 36 references indexed in Scilit:
- Estimation of Functional Residual Capacity at the Bedside Using Standard Monitoring Equipment: A Modified Nitrogen Washout/Washin Technique Requiring a Small Change of the Inspired Oxygen FractionAnesthesia & Analgesia, 2005
- Acute hemodynamic changes during lung recruitment in lavage and endotoxin-induced ALIIntensive Care Medicine, 2004
- Changes in lung volume during recruitment manoeuvres (RM) assessed by electric impedance tomography (EIT)European Journal of Anaesthesiology, 2004
- Effect of alveolar recruitment maneuver in early acute respiratory distress syndrome according to antiderecruitment strategy, etiological category of diffuse lung injury, and body position of the patient*Critical Care Medicine, 2003
- Respective effects of end-expiratory and end-inspiratory pressures on alveolar recruitment in acute lung injury*Critical Care Medicine, 2003
- Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress SyndromeNew England Journal of Medicine, 2000
- Thoracic electrical impedance tomographic measurements during volume controlled ventilation-effects of tidal volume and positive end-expiratory pressureIEEE Transactions on Medical Imaging, 1999
- An experimental study of different ventilatory modes in piglets in severe respiratory distress induced by surfactant depletionIntensive Care Medicine, 1991
- Measurement of Functional Residual Capacity by Sulfur Hexafluoride WashoutAnesthesiology, 1985
- In Vivo Lung Lavage as an Experimental Model of the Respiratory Distress SyndromeActa Anaesthesiologica Scandinavica, 1980