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VOLUME 13 , ISSUE 1 ( March, 2009 ) > List of Articles

RESEARCH ARTICLE

Changes of splanchnic perfusion after applying positive end expiratory pressure in patients with acute respiratory distress syndrome

Prithwis Bhattacharya, Suman Sarkar, Indrajit Kumar, Kruti Sundar Mandal

Keywords : Acute respiratory distress syndrome, gastric mucosal perfusion, positive end-expiratory pressure, tonometry

Citation Information : Bhattacharya P, Sarkar S, Kumar I, Mandal KS. Changes of splanchnic perfusion after applying positive end expiratory pressure in patients with acute respiratory distress syndrome. Indian J Crit Care Med 2009; 13 (1):12-16.

DOI: 10.4103/0972-5229.53109

License: CC BY-ND 3.0

Published Online: 00-03-2009

Copyright Statement:  Copyright © 2009; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Positive end-expiratory pressure (PEEP) improves oxygenation and can prevent ventilator- induced lung injury in patients with acute respiratory distress syndrome (ARDS). Nevertheless, PEEP can also induce detrimental effects by its influence on the cardiovascular system. The purpose of this study was to assess the effects of PEEP on gastric mucosal perfusion while applying a protective ventilatory strategy in patients with ARDS. Materials and Methods: Thirty-two patients were included in the study. A pressure-volume curve was traced and ideal PEEP, defined as lower inflection point + 2cmH 2 O, was determined. Gastric tonometry was measured continuously (Tonocap). After baseline measurements, 10, 15 and 20cmH 2 O PEEP and ideal PEEP were applied for 30 min each. By the end of each period, hemodynamics, CO 2 gap (gastric minus arterial partial pressures), and ventilatory measurements were taken. Results: PEEP had no effect on CO 2 gap (median [range], baseline: 18 [2-30] mmHg; PEEP 10: 18 [0-40] mmHg; PEEP 15: 17 [0-39] mmHg; PEEP 20: 16 [4-39] mmHg; ideal PEEP: 19 [9-39] mmHg; P = 0.19). Cardiac index also remained unchanged (baseline: 4.7 [2.6-6.2] l min−1 m−2; PEEP 10: 4.4 [2.5-7] l min−1 m−2; PEEP 15: 4.4 [2.2-6.8] l min−1 m−2; PEEP 20: 4.8 [2.4-6.3] l min−1 m−2; ideal PEEP: 4.9 [2.4-6.3] l min−1 m−2; P = 0.09). Conclusion: PEEP of 10-20 cmH 2 O does not affect splanchnic perfusion and is hemodynamically well tolerated in most patients with ARDS, including those receiving inotropic supports.


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  1. High inflation pressure pulmonary edema: Respective effects of high airway pressure, high tidal volume and positive end expiratory pressure. Am Rev Respir Dis 1988;137:1159-64.
  2. Stress distribution in lungs: A model of pulmonary toxicity. J Appl Physiol 1970;28:596-608.
  3. Tidal ventilaton at low airway pressures can augment lung injury. Am J Respir Crit Care Med 1994;149:1327-34.
  4. Injurious ventilatory strategies increase cytokines and c-fos m-RNA expression in an isolated rat lung model. J Clin Invest 1997;99:944-52.
  5. Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: A randomized controlled trial. JAMA 1999;282:54-61.
  6. Transcriptional mechanisms of acute lung injury. Am J Physiol Lung Cell Mol Physiol 2001;281:L1037-50.
  7. N Engl J Med 2000;342:1301-8.
  8. Pressure-volume curves of total respiratory system in acute respiratory failure: Computed tomographic scan study. Am Rev Respir Dis 1987;136:730-6.
  9. Regional distribution of gas and tissue in acute respiratory distress syndrome: Consequences for lung morphology, CT Scan ARDS Study Group. Intensive Care Med 2000;26:857-69.
  10. The concept of “baby lung.” Intensive Care Med 2005;31:776-784.
  11. Pulmonary barotrauma in mechanical ventilation. Patterns and risk factors. Chest 1992;102:568-72.
  12. Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: A randomized controlled trial. JAMA 1999;282:54-61.
  13. Recruitment maneuvers in three experimental models of acute lung injury. Am J Respir Crit Care Med 2000;161:1485-94
  14. Effects of periodic lung recruitment maneuvers on gas exchange and respiratory mechanics in mechanically ventilated acute respiratory distress syndrome (ARDS) patients. Intensive Care Med 2000;26:501-7.
  15. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med 2006;354:1775-86.
  16. Dynamics of re-expansion of atelectasis during general anesthesia. Br J Anaesth 1999;82:551-6.
  17. Sigh in acute respiratory distress syndrome. Am J Respir Crit Care Med 1999;159:872-80.
  18. Safety and efficacy of a sustained inflation for alveolar recruitment in adults with respiratory failure. Intensive Care Med 1999;25:1297-301.
  19. Mechanistic scheme and effect of “extended sigh” as a recruitment maneuver in patients with acute respiratory distress syndrome: A preliminary study. Crit Care Med 2001;29:1255-60.
  20. Sigh improves gas exchange and lung volume in patients with acute respiratory distress syndrome undergoing pressure support ventilation. Anesthesiology 2002;96:788-94.
  21. Respiratory effects of different recruitment maneuvers in acute respiratory distress syndrome. Crit Care 2008;12:R50.
  22. Effects of recruiting manoeuvres in patients with acute respiratory distress syndrome ventilated with protective ventilatory strategy. Anesthesiology 2002;96:795-802.
  23. Transient hemodynamic effects of recruitment maneuvers in three experimental models of acute lung injury. Crit Care Med 2004;32:2378-84.
  24. The open lung during small tidal volume ventilation: Concepts of recruitment and “optimal” positive end-expiratory pressure. Crit Care Med 1999;27:1946-52.
  25. Computed tomography assessment of positive end-expiratory pressure-induced alveolar recruitment in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 2001;163:1444-50.
  26. Influence of tidal volume on alveolar recruitment: Respective role of PEEP and a recruitment maneuver. Am J Respir Crit Care Med 2001;163:1609-13.
  27. Effects of recruiting maneuvers in patients with acute respiratory distress syndrome ventilated with protective ventilatory strategy. Anesthesiology 2002; 96:795-802.
  28. Effect of protective ventilation strategy in the acute respiratory distress syndrome. N Engl J Med 1998;338:347-54.
  29. Sigh in acute respiratory distress syndrome. Am J Respir Crit Care Med 1999;159:872-80.
  30. Sigh in supine and prone position during acute respiratory distress syndrome. Am J Respir Crit Care Med 2003;167:521-7.
  31. Prevention of endotracheal suctioning-induced alveolar derecruitment in acute lung injury. Am J Respir Crit Care Med 2003;167:1215-24.
  32. National heart, lung, and blood institute ARDS Clinical Trials Network: Higher versus lower positive end- expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 2004;351:327-36.
  33. Recruitment maneuver and high positive end-expiratory pressure improve hypoxemia in patients after pulmonary thrombendarterectomy for chronic pulmonary thromboembolism. Crit Care Med 2005;33:2010-4.
  34. Effects of lung recruitment maneuver and positive end-expiratory pressure on lung volume, respiratory mechanics and alveolar gas mixing in patients ventilated after cardiac surgery. Acta Anesthesiol Scand 2002;46:717-25.
  35. Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a0 randomized controlled trial. JAMA 2008;299:637-45.
  36. Respiratory-system compliance as seen from the cardiac fossa. J Appl Physiol 1982;53:57-62.
  37. Effect of mechanical ventilation strategy on dissemination of intratracheally instilled Escherichia coli in dogs. Crit Care Med 1997;25:1733-43..
  38. Clinical review: The implications of experimental and clinical studies of recruitment maneuvers in acute lung injury. Crit Care 2004;8:115-21.
  39. Mechanical ventilation may increase susceptibility to the development of bacteremia. Crit Care Med 2003;31:1429-34.
  40. Recruitment maneuver: Does it promote bacterial translocation? Crit Care Med 2002;30:2103-6.
  41. Lung recruitment maneuver in patients with cerebral injury: Effects on intracranial pressure and cerebral metabolism. Intensive Care Med 2002;28:554-8.
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