Objective To evaluate the effect of positive end-expiratory pressure (PEEP) on respiratory function and hemodynamics in acute lung injury (ALI) with intra-abdominal hypertension (IAH).
Methods Six pigs were anesthetized and received mechanical ventilation (MV). Volume controlled ventilation was set with tidal volumn(VT) of 8 mL/kg,respiratory rate(RR) of 16 bpm,inspired oxygen concentration (FiO2) of 0.40,and PEEP of 5 cm H2O. ALI was induced by repeated lung lavage with diluted hydrochloric acid (pH<2.5) until PaO2/FiO2 declined to 150 mm Hg or less to established ALI model. Intra-abdominal hypertension was induced by an nitrogen inflator to reach intra-abdominal pressure of 20 mm Hg. Respiratory parameters and hemodynamics were continuously recorded at different PEEP levels(5,10,15,and 20 cm H2O). Every level was maintained for one hour.
Results PaO2/FiO2 in PEEP5,10,15 and 20 were 90±11,102±10,172±23 and 200±34 mm Hg respectively. PaO2/FiO2 in PEEP15 and 20 were significantly higher than those in PEEP5 and 10 (P<0.05). Chest wall compliance (Ccw) in PEEP5,15 and 20 were 26±3,76±15 and 85±14 mL/cm H2O respectively. Ccw in PEEP15 and 20 were significantly higher than those in PEEP5 (P<0.05). There was no significant difference in lung compliance (CL) in different PEEP levels (P>0.05). Plateau pressure(Pplat) in PEEP5,10,15 and 20 were 30±3,31±2,36±2 and 38±4 cm H2O respectively. Pplat in PEEP15 and 20 were significantly higher than those in PEEP5 and 10 (P<0.05). There was no significant difference in Pplat between PEEP15 and 20 (P>0.05). Heart rate (HR) in PEEP5,15 and 20 were 113±17,147±30,and 160±30 beat/min respectively. HR in PEEP15 and 20 were significantly higher than those in PEEP5 (P<0.05). There was no significant difference in HR between PEEP15 and 20 (P>0.05).Cardiac index (CI) in PEEP5 and 20 were 4.5±0.6 and 3.5±0.6 L·min-1·m-2 respectively. CI in PEEP20 was significantly lower than that in PEEP5 (P<0.05). There was no significant difference in CI in PEEP5,10 or 15(P>0.05). Central venous pressure(CVP) in PEEP5,15 and 20 were 12±2,17±2,and 18±3 mm Hg respectively. CVP in PEEP15 and 20 were significantly higher than those in PEEP5 (P<0.05). There was no significant difference in CVP between PEEP15 and 20 (P>0.05). There were no significant differences in MAP,SVRI,ITBVI,GEDI,PVPI,or EVLWI between different PEEP levels.
Conclusion Concomitant ALI and IAH can induce great impairments in respiratory physiology. When PEEP is gradually increased,oxygenation and the respiratory function are improved without significant secondary hemodynamic disturbances.
Citation：
YanShuying, ZhuangYugang, GeKui, PengHu, ChengYuanzuo, ZhangXiangyu. Impact of Positive End-expiratory Pressure on Respiratory Mechanics and Hemodynamics in Concomitant Acute Lung Injury and Intra-abdominal Hypertension. Chinese Journal of Respiratory and Critical Care Medicine, 2014, 13(4): 360-363. doi: 10.7507/1671-6205.2014088
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Copyright © the editorial department of Chinese Journal of Respiratory and Critical Care Medicine of West China Medical Publisher. All rights reserved
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Malbrain ML,Deeren D,De Potter TJ.Intra-abdominal hypertension in the critically ill:it is time to pay attention.Curr Opin Crit Care,2005,11:156-171.
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De Keulenaer BL,De Waele JJ,Powell B,et al.What is normal intra-abdominal pressure and how is it affected by positioning,body mass and positive end-expiratory pressure?Intensive Care Med,2009,35:969-976.
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Malbrain ML,Cheatham ML,Kirkpatrick A,et al.Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome.I.Definitions.Intensive Care Med,2006,32:1722-1732.
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严姝瑛,陈远卓,彭沪,等.腹腔高压对急性肺损伤猪呼吸系统的影响.同济大学学版:医学版,2012,33:68-71.
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倪海滨,李维勤,柯路,等.跨肺压监测设定呼吸机参数对腹腔高压模型猪血流动力学及氧代谢的作用.中国危重病急救医学,2011,23:555-558.
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Krebs J,Pelosi P,Tsagogiorgas C,et al.Effects of positive end-expiratory pressure on respiratory function and hemodynamics in patients with acute respiratory failure with and without intra-abdominal hypertension:a pilot study.Crit Care,2009,13:R160.
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D'Angelo E,Giglio R,Lafontaine E,et al.Influence of abdomen on respiratory mechanics in supine rabbits.Respir Physiol,1999,115:287-299.
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| 11. |
Agostoni E,D'Angelo E,Bonanni MV.The effect of the abdomen on the vertical gradient of pleural surface pressure.Respir Physiol,1970,8:332-346.
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- 1. Malbrain ML,Deeren D,De Potter TJ.Intra-abdominal hypertension in the critically ill:it is time to pay attention.Curr Opin Crit Care,2005,11:156-171.
- 2. Gattinoni L,Chiumello D,Carlesso E,et al.Bench-to-bed-side review:chest wall elastance in acute lung injury/acute respiratory distress syndrome patients.Crit Care,2004,8:350-355.
- 3. Schachtrupp A,Graf J,Tons C,et al.Intravascular volume depletion in a 24-hour porcine model of intra-abdominal hypertension.J Trauma,2003,55:734-740.
- 4. Amato MB,Barbas CS,Medeiros DM,et al.Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome.N Engl J Med,1998,338:347-354.
- 5. De Keulenaer BL,De Waele JJ,Powell B,et al.What is normal intra-abdominal pressure and how is it affected by positioning,body mass and positive end-expiratory pressure?Intensive Care Med,2009,35:969-976.
- 6. Malbrain ML,Cheatham ML,Kirkpatrick A,et al.Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome.I.Definitions.Intensive Care Med,2006,32:1722-1732.
- 7. 严姝瑛,陈远卓,彭沪,等.腹腔高压对急性肺损伤猪呼吸系统的影响.同济大学学版:医学版,2012,33:68-71.
- 8. 倪海滨,李维勤,柯路,等.跨肺压监测设定呼吸机参数对腹腔高压模型猪血流动力学及氧代谢的作用.中国危重病急救医学,2011,23:555-558.
- 9. Krebs J,Pelosi P,Tsagogiorgas C,et al.Effects of positive end-expiratory pressure on respiratory function and hemodynamics in patients with acute respiratory failure with and without intra-abdominal hypertension:a pilot study.Crit Care,2009,13:R160.
- 10. D'Angelo E,Giglio R,Lafontaine E,et al.Influence of abdomen on respiratory mechanics in supine rabbits.Respir Physiol,1999,115:287-299.
- 11. Agostoni E,D'Angelo E,Bonanni MV.The effect of the abdomen on the vertical gradient of pleural surface pressure.Respir Physiol,1970,8:332-346.
