Physiological effects of different recruitment maneuvers in a pig model of ARDS
Abstract Background In acute respiratory distress syndrome (ARDS), lung recruitment maneuvers can recruit collapsed alveoli in gravity-dependent lung regions, improving the homogeneity of ventilation distribution. This study used electrical impedance tomography to investigate the physiological effec...
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| Format: | Article |
| Language: | English |
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BMC
2020-10-01
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| Series: | BMC Anesthesiology |
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| Online Access: | http://link.springer.com/article/10.1186/s12871-020-01164-x |
| _version_ | 1819000702467309568 |
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| author | Feiping Xia Chun Pan Lihui Wang Ling Liu Songqiao Liu Fengmei Guo Yi Yang Yingzi Huang |
| author_facet | Feiping Xia Chun Pan Lihui Wang Ling Liu Songqiao Liu Fengmei Guo Yi Yang Yingzi Huang |
| author_sort | Feiping Xia |
| collection | DOAJ |
| description | Abstract Background In acute respiratory distress syndrome (ARDS), lung recruitment maneuvers can recruit collapsed alveoli in gravity-dependent lung regions, improving the homogeneity of ventilation distribution. This study used electrical impedance tomography to investigate the physiological effects of different recruitment maneuvers for alveolar recruitment in a pig model of ARDS. Methods ARDS was induced in ten healthy male pigs with repeated bronchoalveolar lavage until the ratio of arterial partial pressure of oxygen (PaO2) of fraction of inspired oxygen (P/F) was < 100 mmHg and remained stable for 30 min (TARDS). ARDS pigs underwent three sequential recruitment maneuvers, including sustained inflation, increments of positive end-expiratory pressure (PEEP), and pressure-controlled ventilation (PCV) applied in random order, with 30 mins at a PEEP of 5 cmH2O between maneuvers. Respiratory mechanics, hemodynamics, arterial blood gas, and electrical impedance tomography were recorded at baseline, TARDS, and before and after each recruitment maneuver. Results In all ten pigs, ARDS was successfully induced with a mean 2.8 ± 1.03 L bronchoalveolar lavages. PaO2, P/F, and compliance were significantly improved after recruitment with sustained inflation, increments of PEEP or PCV (all p < 0.05), and there were no significant differences between maneuvers. Global inhomogeneity index significantly decreased after recruitment with sustained inflation, increments of PEEP, or PCV. There were no significant differences in global inhomogeneity before or after recruitment with the different maneuvers. The decrease in global inhomogeneity index (ΔGI) was significantly greater after recruitment with increments of PEEP compared to sustained inflation (p = 0.023), but there was no significant difference in ΔGI between increments of PEEP and PCV or between sustained inflation and PCV. Conclusion Sustained inflation, increments of PEEP, and PCV increased oxygenation, and regional and global compliance of the respiratory system, and decreased inhomogeneous gas distribution in ARDS pigs. Increments of PEEP significantly improved inhomogeneity of the lung compared to sustained inflation, while there was no difference between increments of PEEP and PCV or between sustained inflation and PCV. |
| first_indexed | 2024-12-20T22:37:31Z |
| format | Article |
| id | doaj.art-d565a169ae674d1082cf852e898a2d98 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-12-20T22:37:31Z |
| publishDate | 2020-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-d565a169ae674d1082cf852e898a2d982022-12-21T19:24:33ZengBMCBMC Anesthesiology1471-22532020-10-012011810.1186/s12871-020-01164-xPhysiological effects of different recruitment maneuvers in a pig model of ARDSFeiping Xia0Chun Pan1Lihui Wang2Ling Liu3Songqiao Liu4Fengmei Guo5Yi Yang6Yingzi Huang7Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityDepartment of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityDepartment of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityDepartment of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityDepartment of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityDepartment of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityDepartment of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityDepartment of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityAbstract Background In acute respiratory distress syndrome (ARDS), lung recruitment maneuvers can recruit collapsed alveoli in gravity-dependent lung regions, improving the homogeneity of ventilation distribution. This study used electrical impedance tomography to investigate the physiological effects of different recruitment maneuvers for alveolar recruitment in a pig model of ARDS. Methods ARDS was induced in ten healthy male pigs with repeated bronchoalveolar lavage until the ratio of arterial partial pressure of oxygen (PaO2) of fraction of inspired oxygen (P/F) was < 100 mmHg and remained stable for 30 min (TARDS). ARDS pigs underwent three sequential recruitment maneuvers, including sustained inflation, increments of positive end-expiratory pressure (PEEP), and pressure-controlled ventilation (PCV) applied in random order, with 30 mins at a PEEP of 5 cmH2O between maneuvers. Respiratory mechanics, hemodynamics, arterial blood gas, and electrical impedance tomography were recorded at baseline, TARDS, and before and after each recruitment maneuver. Results In all ten pigs, ARDS was successfully induced with a mean 2.8 ± 1.03 L bronchoalveolar lavages. PaO2, P/F, and compliance were significantly improved after recruitment with sustained inflation, increments of PEEP or PCV (all p < 0.05), and there were no significant differences between maneuvers. Global inhomogeneity index significantly decreased after recruitment with sustained inflation, increments of PEEP, or PCV. There were no significant differences in global inhomogeneity before or after recruitment with the different maneuvers. The decrease in global inhomogeneity index (ΔGI) was significantly greater after recruitment with increments of PEEP compared to sustained inflation (p = 0.023), but there was no significant difference in ΔGI between increments of PEEP and PCV or between sustained inflation and PCV. Conclusion Sustained inflation, increments of PEEP, and PCV increased oxygenation, and regional and global compliance of the respiratory system, and decreased inhomogeneous gas distribution in ARDS pigs. Increments of PEEP significantly improved inhomogeneity of the lung compared to sustained inflation, while there was no difference between increments of PEEP and PCV or between sustained inflation and PCV.http://link.springer.com/article/10.1186/s12871-020-01164-xElectrical impedance tomographyGlobal inhomogeneityAcute respiratory distress syndrome |
| spellingShingle | Feiping Xia Chun Pan Lihui Wang Ling Liu Songqiao Liu Fengmei Guo Yi Yang Yingzi Huang Physiological effects of different recruitment maneuvers in a pig model of ARDS BMC Anesthesiology Electrical impedance tomography Global inhomogeneity Acute respiratory distress syndrome |
| title | Physiological effects of different recruitment maneuvers in a pig model of ARDS |
| title_full | Physiological effects of different recruitment maneuvers in a pig model of ARDS |
| title_fullStr | Physiological effects of different recruitment maneuvers in a pig model of ARDS |
| title_full_unstemmed | Physiological effects of different recruitment maneuvers in a pig model of ARDS |
| title_short | Physiological effects of different recruitment maneuvers in a pig model of ARDS |
| title_sort | physiological effects of different recruitment maneuvers in a pig model of ards |
| topic | Electrical impedance tomography Global inhomogeneity Acute respiratory distress syndrome |
| url | http://link.springer.com/article/10.1186/s12871-020-01164-x |
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