Effects of two stepwise lung recruitment strategies on respiratory function and haemodynamics in anaesthetised pigs: A randomised crossover study.
Eur J Anaesthesiol
; 38(6): 634-643, 2021 06 01.
Article
em En
| MEDLINE
| ID: mdl-33967255
ABSTRACT
BACKGROUND:
Lung recruitment manoeuvres and positive end-expiratory pressure (PEEP) can improve lung function during general anaesthesia. Different recruitment manoeuvre strategies have been described in large international trials in the protective ventilation using high vs. low PEEP (PROVHILO) strategy, tidal volume (VT) was increased during volume-controlled ventilation; in the individualised peri-operative open-lung approach vs. standard protective ventilation in abdominal surgery (iPROVE) strategy, PEEP was increased during pressure-controlled ventilation.OBJECTIVES:
To compare the effects of the PROVHILO strategy and the iPROVE strategy on respiratory and haemodynamic variables.DESIGN:
Randomised crossover study.SETTING:
University hospital research facility. ANIMALS A total of 20 juvenile anaesthetised pigs.INTERVENTIONS:
Animals were assigned randomly to one of two sequences PROVHILO strategy followed by iPROVE strategy or vice-versa (nâ=â10/sequence). In the PROVHILO strategy, VT was increased stepwise by 4âmlâkg-1 at a fixed PEEP of 12âcmH2O until a plateau pressure of 30 to 35âcmH2O was reached. In the iPROVE strategy, at fixed driving pressure of 20âcmH2O, PEEP was increased up to 20âcmH2O followed by PEEP titration according to the lowest elastance of the respiratory system (ERS). MAIN OUTCOMEMEASURES:
We assessed regional transpulmonary pressure (Ptrans), respiratory system mechanics, gas exchange and haemodynamics, as well as the centre of ventilation (CoV) by electrical impedance tomography.RESULTS:
During recruitment manoeuvres with the PROVHILO strategy compared with the iPROV strategy, dorsal Ptrans was lower at end-inspiration (16.3â±â2.7 vs. 18.6â±â3.1âcmH2O, Pâ=â0.001) and end-expiration (4.8â±â2.6 vs. 8.8â±â3.4âcmH2O, Pâ <â0.001), and mean arterial pressure (MAP) was higher (77â±â11 vs. 60â±â14âmmHg, Pâ<â0.001). At 1 and 15âmin after recruitment manoeuvres, ERS was higher in the PROVHILO strategy than the iPROVE strategy (24.6â±â3.9 vs. 21.5â±â3.4 and 26.7â±â4.3 vs. 24.0â±â3.8âcmH2O l-1; Pâ <â0.001, respectively). At 1âmin, PaO2 was lower in PROVHILO compared with iPROVE strategy (57.1â±â6.1 vs. 59.3â±â5.1âkPa, Pâ=â0.013), but at 15âmin, values did not differ. CoV did not differ between strategies.CONCLUSION:
In anaesthetised pigs, the iPROVE strategy compared with the PROVHILO strategy increased dorsal Ptrans at the cost of lower MAP during recruitment manoeuvres, and decreased ERS thereafter, without consistent improvement of oxygenation or shift of the CoV. TRIAL REGISTRATION This study was registered and approved by the Landesdirektion Dresden, Germany (DD24-5131/338/28).
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Respiração com Pressão Positiva
/
Pulmão
Limite:
Animals
País/Região como assunto:
Europa
Idioma:
En
Revista:
Eur J Anaesthesiol
Assunto da revista:
ANESTESIOLOGIA
Ano de publicação:
2021
Tipo de documento:
Article