nach oben

Intensive Care Medicine

Erschienen in:

01.08.2003 | Original

Do lung recruitment maneuvers decrease gastric mucosal perfusion?

verfasst von: J. Claesson, S. Lehtipalo, O. Winsö

Erschienen in: Intensive Care Medicine | Ausgabe 8/2003

Einloggen, um Zugang zu erhalten

Abstract

Objective

To evaluate effects of lung recruitment maneuvers on gastric mucosal perfusion, systemic circulation, and lung mechanics in patients with acute lung injury.

Design

Prospective observational clinical study.

Setting

General intensive care unit of university hospital.

Patients and participants

Fourteen patients with acute lung injury (ten in the main study group and four in a validation group).

Interventions

Three 2-min-long recruitment maneuvers (RM) with transient increases in mean airway pressure to 35 cmH₂O (RM1 and RM2) and 44 cmH₂O (RM3).

Measurements and results

Measurements of systemic hemodynamics, gastric mucosal perfusion (laser Doppler flowmetry), and lung mechanics were performed immediately before, at the end of, and 3 min after each RM. Cardiac index decreased during all RMs while mean arterial pressure decreased only during RM3. Gastric mucosal perfusion was not significantly changed during any of the RMs. When comparing values obtained before the first RM with values after the third RM there was a significant decrease in cardiac index (P=0.043) and a non-significant (P=0.051) decrease in gastric mucosal perfusion. There were no significant changes in systemic oxygenation or lung mechanics after three RMs, even though four patients showed marked transient increases in systemic oxygenation during RMs.

Conclusions

In this study of ten patients there were no significant changes in gastric mucosal perfusion during lung recruitment maneuvers. There was, however, a trend towards gradual decreases in gastric mucosal perfusion.

Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, LeGall JR, Morris A, Spragg R (1994) The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149:818–824PubMed

Sjostrand UH, Lichtwarck-Aschoff M, Nielsen JB, Markstrom A, Larsson A, Svensson BA, Wegenius GA, Nordgren KA (1995) Different ventilatory approaches to keep the lung open. Intensive Care Med 21:310–318PubMed

Lachmann B (1992) Open up the lung and keep the lung open. Intensive Care Med 18:319–321PubMed

Rothen HU, Sporre B, Engberg G, Wegenius G, Hedenstierna G (1993) Re-expansion of atelectasis during general anaesthesia: a computed tomography study. Br J Anaesth 71:788–795PubMed

Winso O, Biber B, Gustavsson B, Holm C, Milsom I, Niemand D (1986) Portal blood flow in man during graded positive end-expiratory pressure ventilation. Intensive Care Med 12:80–85PubMed

Lehtipalo S, Biber B, Frojse R, Arnerlov C, Johansson G, Winso O (2001) Effects of positive end-expiratory pressure on intestinal circulation during graded mesenteric artery occlusion. Acta Anaesthesiol Scand 45:875–884CrossRefPubMed

De Backer D (2000) The effects of positive end-expiratory pressure on the splanchnic circulation. Intensive Care Med 26:361–363CrossRefPubMed

Dorinsky PM, Whitcomb ME (1983) The effect of PEEP on cardiac output. Chest 84:210–216PubMed

Robotham JL, Cherry D, Mitzner W, Rabson JL, Lixfeld W, Bromberger-Barnea B (1983) A re-evaluation of the hemodynamic consequences of intermittent positive pressure ventilation. Crit Care Med 11:783–793PubMed

10.

Tanaka S, Sagawa S, Miki K, Claybaugh JR, Shiraki K (1994) Changes in muscle sympathetic nerve activity and renal function during positive-pressure breathing in humans. Am J Physiol 266:R1220–1228PubMed

11.

Aneman A, Ponten J, Fandriks L, Eisenhofer G, Friberg P, Biber B (1997) Hemodynamic, sympathetic and angiotensin II responses to PEEP ventilation before and during administration of isoflurane. Acta Anaesthesiol Scand 41:41–48PubMed

12.

Bersten AD, Gnidec AA, Rutledge FS, Sibbald WJ (1990) Hyperdynamic sepsis modifies a PEEP-mediated redistribution in organ blood flows. Am Rev Respir Dis 141:1198–1208PubMed

13.

Aneman A, Eisenhofer G, Fandriks L, Olbe L, Dalenback J, Nitescu P, Friberg P (1999) Splanchnic circulation and regional sympathetic outflow during peroperative PEEP ventilation in humans. Br J Anaesth 82:838–842PubMed

14.

Fujita Y (1993) Effects of PEEP on splanchnic hemodynamics and blood volume. Acta Anaesthesiol Scand 37:427–431PubMed

15.

Rimensberger PC, Cox PN, Frndova H, Bryan AC (1999) The open lung during small tidal volume ventilation: concepts of recruitment and "optimal" positive end-expiratory pressure. Crit Care Med 27:1946–1952

16.

Pelosi P, Cadringher P, Bottino N, Panigada M, Carrieri F, Riva E, Lissoni A, Gattinoni L (1999) Sigh in acute respiratory distress syndrome. Am J Respir Crit Care Med 159:872–880PubMed

17.

Medoff BD, Harris RS, Kesselman H, Venegas J, Amato MB, Hess D (2000) Use of recruitment maneuvers and high-positive end-expiratory pressure in a patient with acute respiratory distress syndrome. Crit Care Med 28:1210–1216PubMed

18.

Lapinsky SE, Aubin M, Mehta S, Boiteau P, Slutsky AS (1999) Safety and efficacy of a sustained inflation for alveolar recruitment in adults with respiratory failure. Intensive Care Med 25:1297–1301PubMed

19.

Lundgren O, Svanvik J (1973) Mucosal hemodynamics in the small intestine of the cat during reduced perfusion pressure. Acta Physiol Scand 88:551–553PubMed

20.

Papa M, Halperin Z, Rubinstein E, Orenstein A, Gafin S, Adar R (1983) The effect of ischemia of the dog's colon on transmural migration of bacteria and endotoxin. J Surg Res 35:264-269PubMed

21.

Landow L, Andersen LW (1994) Splanchnic ischaemia and its role in multiple organ failure. Acta Anaesthesiol Scand 38:626–639PubMed

22.

Biffl WL, Moore EE (1996) Splanchnic ischaemia/reperfusion and multiple organ failure. Br J Anaesth 77:59–70PubMed

23.

Sakka SG, Reinhart K, Meier-Hellman A (1999) Comparison of pulmonary artery and arterial thermodilution cardiac output in critically ill patients. Intensive Care Med 25:843–846CrossRefPubMed

24.

Cheatham ML, Safcsak K (1998) Intraabdominal pressure: a revised method for measurement. J Am Coll Surg 186:594–595PubMed

25.

Karason S, Karlsen KL, Lundin S, Stenqvist O (1999) A simplified method for separate measurements of lung and chest wall mechanics in ventilator-treated patients. Acta Anaesthesiol Scand 43:308–315PubMed

26.

Edouard AR, Degremont AC, Duranteu J, Pussard E, Berdeaux A, Samii K (1994) Heterogeneous regional vascular responses to simulated transient hypovolemia in man. Intensive Care Med 20:403–404PubMed

27.

Ruokonen E, Uusaro A, Alhava E, Takala J (1997) The effect of dobutamine infusion on splanchnic blood flow and oxygen transport in patients with acute pancreatitis. Intensive Care Med 23:732–737PubMed

28.

Vogt J, Reinelt H, Radermacher P (1997) Dobutamine and the oxygen uptake/supply relationship: from global to regional-nothing is simple and easy. Intensive Care Med 23:715–717CrossRefPubMed

29.

Kiefer P, Nunes S, Kosonen P, Takala J (2000) Effect of positive end-expiratory pressure on splanchnic perfusion in acute lung injury. Intensive Care Med 26:376–383CrossRefPubMed

30.

Neviere R, Chagnon J, Vallet B, Lebleu N, Marechal X, Mathieu D, Wattel F, Dupuis B (1997) Dobutamin improves gastrointestinal blood flow in a porcine model of endotoxic shock. Crit Care Med 25:1371–1377PubMed

31.

Hiltebrand LB, Krejci V, Banic A, Erni D, Wheatley AM, Sigurdsson GH (2000) Dynamic study of the distribution of microcirculatory blood flow in multiple splanchnic organs in septic shock. Crit Care Med 28:3233–3241PubMed

32.

Ahn H, Lindhagen J, Nilsson G, Salerud E, Jodal M, Lundgren O (1985) Evaluation of laser Doppler flowmetry in the assessment of intestinal blood flow in cat. Gastroenterology 88:951–957PubMed

33.

Kvietys PR, Shepherd AP, Granger DN (1985) Laser-Doppler, H2 clearance, and microsphere estimates of mucosal blood flow. Am J Physiol 249:G221–227PubMed

34.

Thoren A, Ricksten SE, Lundin S, Gazelius B, Elam M (1998) Baroreceptor-mediated reduction of jejunal mucosal perfusion, evaluated with endoluminal laser Doppler flowmetry in conscious humans. J Auton Nerv Syst 68:157–163CrossRefPubMed

35.

Hulten L, Jodal M, Lindhagen J, Lundgren O (1976) Blood flow in the small intestine of cat and man as analyzed by an inert gas washout technique. Gastroenterology 70:45–51PubMed

36.

Granger DN, Richardson PD, Kvietys PR, Mortillaro NA (1980) Intestinal blood flow. Gastroenterology 78:837–863PubMed

37.

Biber B, Lundgren O, Svanvik J (1971) Studies on the intestinal vasodilatation observed after mechanical stimulation of the mucosa of the gut. Acta Physiol Scand 82:177–190PubMed

38.

Rothen HU, Sporre B, Engberg G, Wegenius G, Hedenstierna G (1993) Re-expansion of atelectasis during general anaesthesia: a computed tomography study. Br J Anaesth 71:788–795PubMed

39.

Rothen HU, Neumann P, Berglund JE, Valtysson J, Magnusson A, Hedenstierna G (1999) Dynamics of re-expansion of atelectasis during general anaesthesia. Br J Anaesth 82:551–556

40.

Markstaller K, Eberle B, Kauczor HU, Scholz A, Bink A, Thelen M, Heinrichs W, Weiler N (2001) Temporal dynamics of lung aeration determined by dynamic CT in a porcine model of ARDS. Br J Anaesth 87:459–468PubMed

41.

Lehtipalo S, Biber B, Frojse R, Arnerlov C, Johansson G, Winso O (2003) Effects of dopexamine and PEEP on intestinal blood flow and oxygenation: The perfusion pressure perspective. Chest (in press)

Titel: Do lung recruitment maneuvers decrease gastric mucosal perfusion?
verfasst von: J. Claesson
S. Lehtipalo
O. Winsö
Publikationsdatum: 01.08.2003
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 8/2003
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-003-1830-z

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

Do lung recruitment maneuvers decrease gastric mucosal perfusion?

Abstract

Objective

Design

Setting

Patients and participants

Interventions

Measurements and results

Conclusions

Neu im Fachgebiet AINS

Akuter Schwindel: Wann lohnt sich eine MRT?

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

Update AINS

Springer Medizin

Abstract

Objective

Design

Setting

Patients and participants

Interventions

Measurements and results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2003

Aerosolization of perfluorocarbons during mechanical ventilation: an in vitro study

Intravenous phosphate in the intensive care unit: More aggressive repletion regimens for moderate and severe hypophosphatemia

Clinically significant gastrointestinal bleeding in critically ill patients with and without stress-ulcer prophylaxis

Is elevated plasma lactate a useful marker in the evaluation of pure carbon monoxide poisoning?

Alveolar recruitment of atelectasis under combined high-frequency jet ventilation: a computed tomography study

Outcome prediction in terms of functional disability and mortality at 1 year among ICU-admitted severe stroke patients: a prospective epidemiological study in the south of the European Union (Evascan Project, Andalusia, Spain)

Neu im Fachgebiet AINS

Akuter Schwindel: Wann lohnt sich eine MRT?

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

Update AINS