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01.08.2010 | Experimental

Effects of preserved spontaneous breathing activity during mechanical ventilation in experimental intra-abdominal hypertension

verfasst von: Dietrich Henzler, Nadine Hochhausen, Ralf Bensberg, Alexander Schachtrupp, Sonja Biechele, Rolf Rossaint, Ralf Kuhlen

Erschienen in: Intensive Care Medicine | Ausgabe 8/2010

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Abstract

Purpose

Ventilation problems are common in critically ill patients with intra-abdominal hypertension. The aim of this study was to investigate the effects of preserved spontaneous breathing during mechanical ventilation on hemodynamics, gas exchange, respiratory function and lung injury in experimental intra-abdominal hypertension.

Methods

Twenty anesthetized pigs were intubated and ventilated for 24 h with biphasic positive airway pressure without (BIPAP_PC) or with additional, unsynchronized spontaneous breathing (BIPAP_SB). In 12 animals, intra-abdominal pressure was increased to 30 mmHg for two 9 h periods followed by a 3 h pressure relief each. Eight animals served as controls and were ventilated for 24 h. Hemodynamics, gas exchange and respiratory mechanics were measured and lung injury was determined histologically.

Results

Intra-abdominal hypertension caused significant impairment of hemodynamics and respiratory mechanics in both modes. In the presence of intra-abdominal hypertension, BIPAP_SB did not demonstrate superior respiratory mechanics and cardiovascular stability as compared to BIPAP_PC. Although the decrease of dynamic compliance and the increase of airway pressures were mitigated, BIPAP_SB failed to lower pulmonary vascular resistance and caused increased dead space ventilation (p = 0.007). Blood pressures and cardiac output increased in BIPAP_SB, caused by an increase in heart rate (p < 0.001), but not in stroke volume (p = 0.06). BIPAP_SB was associated with an increased breathing effort, decreased transpulmonary pressure during inspiration and lower lobe diffuse alveolar damage (p = 0.002).

Conclusions

In the presence of severe intra-abdominal hypertension, the addition of unsupported spontaneous breaths to BIPAP did not improve hemodynamic and respiratory function and caused greater histopathologic damage to the lungs.

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Titel: Effects of preserved spontaneous breathing activity during mechanical ventilation in experimental intra-abdominal hypertension
verfasst von: Dietrich Henzler
Nadine Hochhausen
Ralf Bensberg
Alexander Schachtrupp
Sonja Biechele
Rolf Rossaint
Ralf Kuhlen
Publikationsdatum: 01.08.2010
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 8/2010
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-010-1827-3

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Effects of preserved spontaneous breathing activity during mechanical ventilation in experimental intra-abdominal hypertension

Abstract

Purpose

Methods

Results

Conclusions

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Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

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