Effects of positive end-expiratory pressure and body position on pulmonary blood flow redistribution in mechanically ventilated normal pigs.
OBJECTIVE
To assess the respective effects of position and positive end-expiratory pressure (PEEP) on the distribution of regional pulmonary blood flow (PBF).


METHODS
Prospective randomized animal study.


METHODS
Animal research facility in a university hospital.


METHODS
Normal pigs that were tracheostomized, anesthetized, and mechanically ventilated.


METHODS
PBF was measured in seven pigs in the supine position (SP) and the prone position (PP) at both zero end-expiratory pressure (ZEEP) and 10 cm H(2)O of PEEP. The regional PBF was assessed by the radioactive microsphere method. The lungs from each pig were sliced into 90 samples. The heterogeneity of PBF was estimated from its coefficient of variation.


RESULTS
The lung samples had a mean (+/- SD) weight of 1.60 +/- 0.39 g. Changing position from SP to PP at ZEEP redistributed PBF toward the anterior, superior, and peripheral regions and did not significantly reduce the coefficient of variation for regional PBF (reduction, 44.7 +/- 7% to 42.2 +/- 8%). Changing from the SP to PP position at PEEP induced a similar, but more marked, redistribution of PBF and a significant reduction in the coefficient of variation from 53 +/- 13% to 30.4 +/- 7% (p < 0.001). In the SP, PEEP redistributed PBF toward the posterior, inferior, and central regions without changing the heterogeneity of PBF. In the PP, PEEP had little effect on the PBF redistribution but significantly reduced the coefficient of variation of PBF from 42.2 +/- 8% to 30.4 +/- 7% (p < 0.05).


CONCLUSIONS
Pigs in the PP had altered gravitational dependence of PBF compared to that observed when pigs were in the SP. This effect was enhanced by using a PEEP of 10 cm H(2)O.
Richard
Jean-Christophe
JC
Centre Etude et de Recherches en Tomographie par Emission de Positrons, Hôpital Neuro-Cardiologique, Lyon, France.
Decailliot
Francois
F
Janier
Marc
M
Annat
Guy
G
Guérin
Claude
C
D000818:Animals; D005260:Female; D006112:Gravitation; D008168:Lung / Q000098:blood supply*; D008297:Male; D011175:Positive-Pressure Respiration; D011187:Posture / Q000502:physiology*; D012039:Regional Blood Flow / Q000502:physiology; D013552:Swine