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01-03-2008 | Brief Report

Spontaneous breathing during airway pressure release ventilation in experimental lung injury: effects on hepatic blood flow

Authors: Rudolf Hering, Jens Christopher Bolten, Stefan Kreyer, Andreas Berg, Hermann Wrigge, Jörg Zinserling, Christian Putensen

Published in: Intensive Care Medicine | Issue 3/2008

Abstract

Objective

Positive pressure ventilation can affect systemic haemodynamics and regional blood flow distribution with negative effects on hepatic blood flow. We hypothesized that spontaneous breathing (SB) with airway pressure release ventilation (APRV) provides better systemic and hepatic blood flow than APRV without SB.

Design

Animal study with a randomized cross-over design.

Setting

Animal laboratory of Bonn University Hospital.

Subjects

Twelve pigs with oleic-acid-induced lung injury.

Interventions

APRV with or without SB in random order. Without SB, either the upper airway pressure limit or the ventilator rate was increased to maintain constant pH and PaCO₂.

Measurements and results

Systemic haemodynamics were determined by double-indicator dilution, organ blood flow by coloured microspheres. Systemic blood flow was best during APRV with SB. During APRV with SB blood flow (ml g⁻¹ min⁻¹) was 0.91 ± 0.26 (hepatic arterial), 0.29 ± 0.05 (stomach), 0.64 ± 0.08 (duodenum), 0.62 ± 0.10 (jejunum), 0.53 ± 0.07 (ileum), 0.53 ± 0.07 (colon), 0.46 ± 0.09 (pancreas) and 3.59 ± 0.55 (spleen). During APRV without SB applying high P_aw it decreased to 0.13 ± 0.01 (stomach), 0.37 ± 0.03 (duodenum), 0.29 ± 0.03 (jejunum), 0.31 ± 0.05 (ileum), 0.32 ± 0.03 (colon) and 0.23 ± 0.04 (pancreas) p < 0.01, respectively. During APRV without SB applying same P_aw limits it decreased to 0.18 ± 0.03 (stomach, p < 0.01), 0.47 ± 0.06 (duodenum, p < 0.05), 0.38 ± 0.05 (jejunum, p < 0.01), 0.36 ± 0.03 (ileum, p < 0.05), 0.39 ± 0.05 (colon, p < 0.05), and 0.27 ± 0.04 (pancreas, p < 0.01). Arterial liver blood flow did not change significantly when SB was abolished (0.55 ± 0.11 and 0.63 ± 0.11, respectively).

Conclusions

Maintaining SB during APRV was associated with better systemic and pre-portal organ blood flow. Improvement in hepatic arterial blood flow was not significant.

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Title: Spontaneous breathing during airway pressure release ventilation in experimental lung injury: effects on hepatic blood flow
Authors: Rudolf Hering
Jens Christopher Bolten
Stefan Kreyer
Andreas Berg
Hermann Wrigge
Jörg Zinserling
Christian Putensen
Publication date: 01-03-2008
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 3/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-007-0957-8

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Springer Medicine

Spontaneous breathing during airway pressure release ventilation in experimental lung injury: effects on hepatic blood flow

Abstract

Objective

Design

Setting

Subjects

Interventions

Measurements and results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design

Setting

Subjects

Interventions

Measurements and results

Conclusions

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