Hemodynamic effects of PEEP in a porcine model of HCl-induced mild acute lung injury

Autor(es)

Marumo, C. K. ^[1] ; Otsuki, D. A. ^[1] ; Fantoni, D. T. ^[2] ; Margarido, C. B. ^[1] ; Ambrosio, A. M. ^[2] ; Pelosi, P. ^[3] ; Auler, Jr., J. O. C. ^{[4, 5]}

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Fac Med, Lab Med Investigat LIM08, BR-O5403000 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Med Vet & Zootecnia, Dept Surg, BR-O5403000 Sao Paulo - Brazil

^[3] Univ Insubria, Dept Ambient Hlth & Safety, Varese - Italy

^[4] Univ Sao Paulo, Fac Med, Hosp Clin, Inst Coracao, Anesthesia Dept, BR-O5403000 Sao Paulo - Brazil

^[5] Univ Sao Paulo, Fac Med, Hosp Clin, Inst Coracao, Surg ICU, BR-O5403000 Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: ACTA ANAESTHESIOLOGICA SCANDINAVICA; v. 53, n. 2, p. 190-202, FEB 2009.
• Citações Web of Science: 4

Resumo

Positive end-expiratory pressure (PEEP) and sustained inspiratory insufflations (SI) during acute lung injury (ALI) are suggested to improve oxygenation and respiratory mechanics. We aimed to investigate the hemodynamic effects of PEEP with and without alveolar recruiting maneuver in a mild ALI model induced by inhalation of hydrochloric acid. Thirty-two pigs were randomly allocated into four groups (Control-PEEP, Control-SI, ALI-PEEP and ALI-SI). ALI was induced by intratracheal instillation of hydrochloric acid. PEEP values were progressively increased and decreased from 5, 10, 15 and 20 cmH(2)O in all groups. Three SIs maneuvers of 30 cmH(2)O for 20 s were applied to the assignable groups between each PEEP level. Transesophageal echocardiography (TEE), global hemodynamics, oxygenation indexes and gastric tonometry were measured 5 min after the maneuvers had been concluded and at each established value of PEEP (5, 10, 15 and 20 cmH(2)O). The cardiac index, ejection fraction and end-diastolic volume of right ventricle were significantly (P < 0.001) decreased with PEEP in both Control and ALI groups. Left ventricle echocardiography showed a significant decrease in end-diastolic volume at 20 cmH(2)O of PEEP (P < 0.001). SIs did not exert any significant hemodynamic effects either early (after 5 min) or late (after 3 h). In a mild ALI model induced by inhalation of hydrochloric acid, significant hemodynamic impairment characterized by cardiac function deterioration occurred during PEEP increment, but SI, probably due to low applied values (30 cmH(2)O), did not exert further negative hemodynamic effects. PEEP should be used cautiously in ALI caused by acid gastric content inhalation. (AU)

• Processo FAPESP: 03/06359-9 - Efeito das manobras de recrutamento alveolar no sistema cardiovascular durante lesão pulmonar por ácido clorídrico: estudo experimental através de avaliação ecocardiográfica e hemodinâmica
• Beneficiário: José Otávio Costa Auler Junior
• Modalidade de apoio: Auxílio à Pesquisa - Regular
• Processo FAPESP: 02/08621-0 - Estudo da influência das manobras de recrutamento alveolar sobre o parênquima pulmonar durante lesão isolada aguda do pulmão promovida pela instilação de ácido clorídrico a 0,05n: estudo experimental
• Beneficiário: Denise Tabacchi Fantoni
• Modalidade de apoio: Auxílio à Pesquisa - Regular