Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Intensive Care Medicine
Published in: Intensive Care Medicine 4/2006

01-04-2006 | Experimental

Central hemodynamics during lung recruitment maneuvers at hypovolemia, normovolemia and hypervolemia. A study by echocardiography and continuous pulmonary artery flow measurements in lung-injured pigs

Authors: Jonas Nielsen, Manja Nilsson, Filip Fredén, Jan Hultman, Ulrica Alström, Jesper Kjærgaard, Göran Hedenstierna, Anders Larsson

Published in: Intensive Care Medicine | Issue 4/2006

Login to get access

Abstract

Objective

The impact of lung-recruitment maneuvers on heart function at different volemic levels has not been studied in detail. We therefore investigated the effect on central hemodynamics of lung recruitment maneuvers at hypovolemia, normovolemia and hypervolemia in experimental lung injury.

Design

Randomized, controlled, cross-over experimental study.

Setting

Animal laboratory at a university hospital. Participants: Eleven anesthetized and lung-lavaged pigs.

Intervention

The animals were randomized to 10-s lung recruitment maneuvers followed by 30-s maneuvers (40 cm H2O airway pressure) or vice versa, performed under hypovolemia, normovolemia and hypervolemia.

Measurements and main results

Left-ventricular end-diastolic diameter and cardiac output were measured before, during, and 1 min and 5 min after the lung recruitment maneuver and left-ventricular eccentricity index was calculated for before and during the maneuver. Cardiac output and left-ventricular end-diastolic diameter (within parentheses) decreased significantly during both the 10-s and 30-s lung recruitment maneuvers at hypovolemia, by a mean of 89% (35) and 92% (33), at normovolemia by 75% (33) and 86% (32), and at hypervolemia by 56% (32) and 64% (43), respectively. At hypovolemia, cardiac output was increased above baseline 1–5 min following the 30-s maneuver. Left-ventricular eccentricity index increased significantly during the maneuver, indicating right ventricular dysfunction.

Conclusions

In this animal lung injury model, lung recruitment maneuvers significantly decreased left-ventricular end-diastolic volume and cardiac output at hypovolemia. Hypervolemia did partly counteract this compromise. In addition, a marked right-ventricular dysfunction during the maneuver was found.
Appendix
Available only for authorised users
Literature
1.
Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, LeGall JR, Morris A, Spragg R (1994) Report of the American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination. The Consensus Committee. Intensive Care Med 20:225–232PubMedCrossRef
2.
Sachdeva SP (1974) Treatment of post-operative pulmonary atelectasis by active inflation of the atelectatic lobe(s) through an endobronchial tube. Acta Anaesthesiol Scand 18:65–70PubMed
3.
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 71:788–795PubMedCrossRef
4.
Magnusson L, Wicky S, Tyden H, Hedenstierna G (1998) Repeated vital capacity manoeuvres after cardiopulmonary bypass: effects on lung function in a pig model. Br J Anaesth 80:682–684PubMed
5.
Dyhr T, Laursen N, Larsson A (2002) 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 Anaesthesiol Scand 46:717–725PubMedCrossRef
6.
Grasso S, Mascia L, Del Turco M, Malacarne P, Giunta F, Brochard L, Slutsky AS, Marco Ranieri V (2002) Effects of recruiting maneuvers in patients with acute respiratory distress syndrome ventilated with protective ventilatory strategy. Anesthesiology 9:795–802CrossRef
7.
Claxton BA, Morgan P, McKeague H, Mulpur A, Berridge J (2003) Alveolar recruitment strategy improves arterial oxygenation after cardiopulmonary bypass. Anaesthesia 58:111–116PubMedCrossRef
8.
Jardin F, Vieillard-Baron A (2003) Right ventricular function and positive pressure ventilation in clinical practice: from hemodynamic subsets to respirator settings. Intensive Care Med 29:1426–1434PubMedCrossRef
9.
Pinsky MR (1997) The hemodynamic consequences of mechanical ventilation: an evolving story. Intensive Care Med 23:493–503PubMedCrossRef
10.
Permutt S, Bromberger-Barnea B, Bane HN (1962) Alveolar pressure, pulmonary venous pressure, and the vascular waterfall. Med Thorac 19:239–260PubMed
11.
Bein T, Kuhr LP, Bele S, Ploner F, Keyl C, Taeger K (2002) Lung recruitment maneuver in patients with cerebral injury: effects on intracranial pressure and cerebral metabolism. Intensive Care Med 28:554–558PubMedCrossRef
12.
Claesson J, Lehtipalo S, Winso O (2003) Do lung recruitment maneuvers decrease gastric mucosal perfusion? Intensive Care Med 29:1314–1321PubMedCrossRef
13.
Nunes S, Rothen HU, Brander L, Takala J, Jakob SM (2004) Changes in splanchnic circulation during an alveolar recruitment maneuver in healthy porcine lungs. Anesth Analg 98:1432–1438PubMedCrossRef
14.
Odenstedt H, Aneman A, Karason S, Stenqvist O, Lundin S (2005) Acute hemodynamic changes during lung recruitment in lavage and endotoxin-induced ALI. Intensive Care Med 31:112–120PubMedCrossRef
15.
Lim SC, Adams AB, Simonson DA, Dries DJ, Broccard AF, Hotchkiss JR, Marini JJ (2004) Transient hemodynamic effects of recruitment maneuvers in three experimental models of acute lung injury. Crit Care Med 32:2378–2384PubMedCrossRef
16.
Fujino Y, Goddon S, Dolhnikoff M, Hess D, Amato MB, Kacmarek RM (2001) Repetitive high-pressure recruitment maneuvers required to maximally recruit lung in a sheep model of acute respiratory distress syndrome. Crit Care Med 29:1579–1586PubMedCrossRef
17.
Nielsen J, Ostergaard M, Kjaergaard J, Tingleff J, Berthelsen PG, Nygard E, Larsson A (2005) Lung recruitment maneuver depresses central hemodynamics in patients following cardiac surgery. Intensive Care Med 31(9):1189–1194PubMedCrossRef
18.
Nielsen J, Nilsson M, Freden F, Alstrom U, Hultman J, Larsson A (2005) Lung recruitment maneuvers seriously affect central hemodynamics during hypovolemia. Crit Care Med 32 (12) [Suppl]:A120
19.
Neumann P, Berglund JE, Mondejar EF, Magnusson A, Hedenstierna G (1998) Dynamics of lung collapse and recruitment during prolonged breathing in porcine lung injury. J Appl Physiol 85:1533–1543PubMed
20.
Ryan T, Petrovic O, Dillon JC, Feigenbaum H, Conley MJ, Armstrong WF (1985) An echocardiographic index for separation of right ventricular volume and pressure overload. J Am Coll Cardiol 5:918–927PubMedCrossRef
21.
Larsson A, Linnarsson D, Jonmarker C, Jonson B, Larsson H, Werner O (1987) Measurement of lung volume by sulfur hexafluoride washout during spontaneous and controlled ventilation: further development of a method. Anesthesiology 67:543–550PubMedCrossRef
22.
von Englehardt W (1966) Swine cardiovascular physiology: A review. In: Bustad LK, Mclellan RO (eds) Swine in biomedical research. Frayn, Seattle, pp 307–329
23.
Lim SC, Adams AB, Simonson DA, Dries DJ, Broccard AF, Hotchkiss JR, Marini JJ (2004) Intercomparison of recruitment-maneuver efficacy in three models of acute lung injury. Crit Care Med 32:2371–2377PubMedCrossRef
24.
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 25:1297–1301PubMedCrossRef
25.
Dyhr T, Bonde J, Larsson A (2003) Lung recruitment manoeuvres are effective in regaining lung volume and oxygenation after open endotracheal suctioning in acute respiratory distress syndrome. Crit Care 7:55–62PubMedCrossRef
26.
Vieillard-Baron A, Loubieres Y, Schmitt JM, Page B, Dubourg O, Jardin F (1999) Cyclic changes in right ventricular output impedance during mechanical ventilation. J Appl Physiol 87:1644–1650PubMed
27.
Jardin F, Farcot JC, Boisante L, Curien N, Margairaz A, Bourdarias JP (1981) Influence of positive end-expiratory pressure on left ventricular performance. N Engl J Med 304:387–392PubMedCrossRef
28.
Cheung AT, Savino JS, Weiss SJ, Aukburg SJ, Berlin JA (1994) Echocardiographic and hemodynamic indexes of left ventricular preload in patients with normal and abnormal ventricular function. Anesthesiology 81:376–387PubMedCrossRef
29.
Nishimura RA, Tajik AJ (1986) The Valsalva maneuver and response revisited. Mayo Clin Proc 61:211–217PubMed
30.
Sharpey-Schafer EP (1955) Effects of Valsalva's manoeuvre on the normal and failing circulation. Br Med J 4915:693–695CrossRef
31.
Maggiorini M, Brimioulle S, De Canniere D, Delcroix M, Naeije R (1998) Effects of pulmonary embolism on pulmonary vascular impedance in dogs and minipigs. J Appl Physiol 84:815--821PubMed
Metadata
Title
Central hemodynamics during lung recruitment maneuvers at hypovolemia, normovolemia and hypervolemia. A study by echocardiography and continuous pulmonary artery flow measurements in lung-injured pigs
Authors
Jonas Nielsen
Manja Nilsson
Filip Fredén
Jan Hultman
Ulrica Alström
Jesper Kjærgaard
Göran Hedenstierna
Anders Larsson
Publication date
01-04-2006
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 4/2006
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-006-0082-0

Other articles of this Issue 4/2006

Intensive Care Medicine 4/2006 Go to the issue

Original

Transmission of SARS to healthcare workers. The experience of a Hong Kong ICU

Correspondence

Tight glycaemic control: a survey of intensive care practice in the Netherlands

Correspondence

Activated protein C: do more survive?

Pediatric Correspondence

Accidental ecstasy intoxication in an 8-month-old infant

Correspondence

Authors' reply to the comment by Dr. Oud

Original

The changing pathogens of complicated parapneumonic effusions or empyemas in a medical intensive care unit