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. 2015 Jul 31:15:82.
doi: 10.1186/s12890-015-0079-y.

Cardiorespiratory effects of recruitment maneuvers and positive end expiratory pressure in an experimental context of acute lung injury and pulmonary hypertension

Camille Doras  1 , Morgan Le Guen  2 , Ferenc Peták  3 , Walid Habre  4   5
Affiliations

Cardiorespiratory effects of recruitment maneuvers and positive end expiratory pressure in an experimental context of acute lung injury and pulmonary hypertension

Camille Doras et al. BMC Pulm Med. .

Abstract

Background: Recruitment maneuvers (RM) and positive end expiratory pressure (PEEP) are the cornerstone of the open lung strategy during ventilation, particularly during acute lung injury (ALI). However, these interventions may impact the pulmonary circulation and induce hemodynamic and respiratory effects, which in turn may be critical in case of pulmonary hypertension (PHT). We aimed to establish how ALI and PHT influence the cardiorespiratory effects of RM and PEEP.

Methods: Rabbits control or with monocrotaline-induced PHT were used. Forced oscillatory airway and tissue mechanics, effective lung volume (ELV), systemic and right ventricular hemodynamics and blood gas were assessed before and after RM, during baseline and following surfactant depletion by whole lung lavage.

Results: RM was more efficient in improving respiratory elastance and ELV in the surfactant-depleted lungs when PHT was concomitantly present. Moreover, the adverse changes in respiratory mechanics and ELV following ALI were lessened in the animals suffering from PHT.

Conclusions: During ventilation with open lung strategy, the role of PHT in conferring protection from the adverse respiratory consequences of ALI was evidenced. This finding advocates the safety of RM and PEEP in improving elastance and advancing lung reopening in the simultaneous presence of PHT and ALI.

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Figures

Fig. 1
Fig. 1
Experimental protocol
Fig. 2
Fig. 2
Right ventricle end diastolic pressure (EDP), heart rate (HR), weighted cardiac output (CO) and mean arterial pressure (MAP), before and after RM, during baseline (black symbols) or ALI (open symbols), in control (circle) and PHT (triangle) animals, at 2 levels of PEEP. Statistical relevance of * RM, # PHT, § PEEP
Fig. 3
Fig. 3
Airway resistance (Raw), tissue damping (G), tissue elastance (H) and effective lung volume (ELV), before and after RM, during baseline (black symbols) or ALI (open symbols), in control (circle) and PHT (triangle) animals, at 2 levels of PEEP. Statistical relevance of * RM, # PHT, § PEEP
Fig. 4
Fig. 4
Comparison of the relative change induced by ALI in Raw, G, H and ELV between control and PHT rabbits, at 2 levels of PEEP
Fig. 5
Fig. 5
Carbon dioxide arterial partial pressure (PaCO2), oxygen venous saturation (SvO2) and oxygen arterial partial pressure / inspired fraction ratio (PaO2/FiO2), before and after RM, during baseline (black symbols) or ALI (open symbols), in control (circle) and PHT (triangle) animals, at 2 levels of PEEP. Statistical relevance of * RM, # PHT, § PEEP
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