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Do lung recruitment maneuvers decrease gastric mucosal perfusion?
Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap.
2003 (Engelska)Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 29, nr 8, s. 1314-1321Artikel i tidskrift (Refereegranskat) Published
Ort, förlag, år, upplaga, sidor
2003. Vol. 29, nr 8, s. 1314-1321
Identifikatorer
URN: urn:nbn:se:umu:diva-5682DOI: 10.1007/s00134-003-1830-zOAI: oai:DiVA.org:umu-5682DiVA, id: diva2:145279
Tillgänglig från: 2007-01-29 Skapad: 2007-01-29 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
Ingår i avhandling
1. Intestinal effects of lung recruitment maneuvers
Öppna denna publikation i ny flik eller fönster >>Intestinal effects of lung recruitment maneuvers
2007 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background and aims: Lung recruitment maneuvers (brief episodes of high airway pressure) are a modern treatment alternative to achieve open lung conditions under mechanical ventilation of patients with acute lung injury. It is well known that positive pressure ventilation with high airway pressures cause negative circulatory effects, and that the effects on regional vascular beds can be even more pronounced than the systemic effects. Hypoperfusion of the mesenteric vascular bed can lead to tissue ischemia and local inflammation. This intestinal inflammation has been associated with subsequent development of multiple organ dysfunction syndrome, a syndrome that still carries a high mortality and is a leading cause of death for intensive care patients. The aim of this thesis was therefore to investigate whether lung recruitment maneuvers would cause negative effects on mesenteric circulation, oxygenation or metabolism.

Methods and results: In an initial study on ten patients with acute lung injury, we could demonstrate a trend towards a decreased gastric mucosal perfusion during three repeated lung recruitment maneuvers. To more closely examine this finding, we set up an oleic acid lung injury model in pigs, and in our second study we established that this model was devoid of inherent intestinal effects and was adequate for subsequent studies of intestinal effects of lung recrutiment maneuvers. In the acute lung injury model, we also tested the effect of an infusion of a vasodilating agent concurrent with the recruitment maneuvers, the hypothesis being that a vasodilating agent would prevent intestinal vasoconstriction and hypoperfusion. We could show that three repeated lung recruitment maneuvers induced short term negative effects on mesenteric oxygenation and metabolism, but that these findings were transient and short lasting. Further, the effects of prostacyclin were minor and opposing. These findings of relative little impact on the intestines of lung recruitment maneuvers, lead us to investigate the hypothesis that repeated recruitment maneuvers maybe could elicite a protective intestinal preconditioning response, a phenomenon previously described both in the rat and in the dog. However, in our fourth study, using both classical ischemic preconditioning with brief periods of intestinal ischemia or repeated lung recrutiment maneuvers, we could not demonstrate the phenomenon of intestinal preconditioning in the pig.

Conclusions: We conclude, that from a mesenteric point of view, lung recruitment maneuvers are safe, and only induce transient and short lasting negative effects. We also conclude that the cause of the minor effects of lung recruitment maneuvers is not dependent on intestinal preconditioning.

Ort, förlag, år, upplaga, sidor
Umeå: Kirurgisk och perioperativ vetenskap, 2007. s. 92
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1083
Nyckelord
acute lung injury, oleic acid lung injury, ischemia, reperfusion injury, swine, mechanical ventilation, lung recruitment, splanchnic circulation, laser Doppler flowmetry, tissue oxygen tension, microdialysis, lactate, glycerol
Nationell ämneskategori
Anestesi och intensivvård
Forskningsämne
lungmedicin
Identifikatorer
urn:nbn:se:umu:diva-981 (URN)978-91-7264-254-6 (ISBN)
Disputation
2007-02-23, Sal B, 9 tr, Tandläkarhögskolan, 90185, Umeå, 13:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2007-01-29 Skapad: 2007-01-29 Senast uppdaterad: 2009-05-15Bibliografiskt granskad

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Lehtipalo, StefanWinsö, Ola

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