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Negative mesenteric effects of lung recruitment maneuvers in oleic acid lung injury are transient and short lasting.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology. Anestesiologi och intensivvård.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology. Anestesiologi och intensivvård.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology. Anestesiologi och intensivvård.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Kirurgi.
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2007 (English)In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 35, no 1, 230-238 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To test the hypothesis that repeated recruitment maneuvers (RMs) have sustained negative effects on mesenteric circulation, metabolism, and oxygenation 60 mins after RMs in pigs with oleic acid lung injury. Further, we aimed to test the hypothesis that an infusion of prostacyclin (PC) at 33 ng.kg.min would attenuate such possible negative mesenteric effects. DESIGN: Randomized, experimental, controlled study. SETTING: University hospital animal laboratory. SUBJECTS: A total of 31 anesthetized, fluid-resuscitated pigs with oleic acid lung injury. INTERVENTIONS: Animals were randomized to one of the following four groups: a control group (n = 7) that received no intervention, recruitment group (n = 8) that underwent the RM sequence, a prostacyclin group (n = 8) that received an infusion of PC, and a recruitment-prostacyclin group (n = 8) that received an infusion of PC and concomitant RM sequence. MEASUREMENTS AND MAIN RESULTS: We measured systemic and mesenteric hemodynamic variables, jejunal mucosal perfusion, mesenteric lactate flux, jejunal tissue oxygen tension, and mesenteric oxygen delivery, uptake, and extraction ratio. Five minutes after RMs, mesenteric oxygen extraction ratio and mesenteric lactate flux were more prominently increased in the recruitment group, giving evidence of worsened mesenteric conditions after RMs. These signs of worsened conditions were further supported by more decreased jejunal tissue oxygen tension and portal vein oxygen saturation in the recruitment group. PC preserved mesenteric oxygenation, as indicated by less of a decrease in portal vein oxygen saturation at the time corresponding to 5 mins after RM and less of a decrease in mesenteric oxygen delivery at the time corresponding to 15 mins after RM. PC preserved mesenteric oxygenation as indicated by less of a decrease in portal vein oxygen saturation at 5 mins after RM and an attenuated increase in mesenteric oxygen extraction ratio at 5 mins after RM. There was a trend toward worsened jejunal mucosal perfusion, although not significant. CONCLUSIONS: In an oleic acid lung injury model, three repeated RMs did not improve systemic oxygenation or lung mechanics. Negative effects on mesenteric oxygenation and metabolism were transient and short lasting. The intestinal effects of PC during RMs were minor and opposing, showing preserved oxygenation but a trend toward worsened mucosal perfusion.

Place, publisher, year, edition, pages
2007. Vol. 35, no 1, 230-238 p.
Keyword [en]
Animals, Antihypertensive Agents/pharmacology/*therapeutic use, Blood Flow Velocity/drug effects, Blood Gas Analysis, Blood Pressure/drug effects, Cardiac Output/drug effects, Disease Models; Animal, Drug Evaluation; Preclinical, Epoprostenol/pharmacology/*therapeutic use, Female, Infusions; Intravenous, Intestinal Mucosa/blood supply/drug effects/metabolism, Jejunum/blood supply/drug effects/metabolism, Lactic Acid/metabolism, Lung Volume Measurements, Oleic Acid, Oxygen Consumption/drug effects, Random Allocation, Respiration; Artificial/adverse effects/methods, Respiratory Distress Syndrome; Adult/chemically induced/metabolism/physiopathology/*therapy, Respiratory Mechanics/drug effects, Splanchnic Circulation/drug effects, Swine, Time Factors
Identifiers
URN: urn:nbn:se:umu:diva-7123PubMedID: 17110875OAI: oai:DiVA.org:umu-7123DiVA: diva2:146794
Available from: 2008-01-04 Created: 2008-01-04 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Intestinal effects of lung recruitment maneuvers
Open this publication in new window or tab >>Intestinal effects of lung recruitment maneuvers
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Umeå: Kirurgisk och perioperativ vetenskap, 2007. 92 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1083
Keyword
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
National Category
Anesthesiology and Intensive Care
Research subject
Lung Medicine
Identifiers
urn:nbn:se:umu:diva-981 (URN)978-91-7264-254-6 (ISBN)
Public defence
2007-02-23, Sal B, 9 tr, Tandläkarhögskolan, 90185, Umeå, 13:00 (English)
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Supervisors
Available from: 2007-01-29 Created: 2007-01-29 Last updated: 2009-05-15Bibliographically approved

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