title: Changes in splanchnic circulation during an alveolar recruitment maneuver in healthy porcine lungs.
abstract: Recruitment maneuvers (RM) are advocated as a complement to mechanical ventilation during anesthesia and in acute lung injury. However, they produce high intrathoracic pressures and volumes that may compromise hemodynamics. Our aim was to analyze the effect of a RM on hemodynamics in 10 anesthetized pigs. We assessed carotid, pulmonary, femoral, and hepatic arterial pressures, hepatic and portal venous pressures, total splanchnic (celiac trunk + superior mesenteric artery), hepatic, splenic, renal, and carotid arterial flows, and portal venous flow. We recorded hemodynamics, respiratory mechanics and blood gases before and at 8 min after RM (sustained inflation to 40 cm H(2)O of airway pressure lasting 20 s). Hemodynamics were also measured during RM, and at 1, 3, and 5 min after RM. All flows (P = 0.030) and arterial pressures (P < or = 0.048) decreased during RM, whereas venous pressures increased (P = 0.030). Flows and pressures returned to 75%-109% of baseline immediately after RM. Total splanchnic, renal and portal flows remained decreased at 8 min after RM (P < or = 0.042). Oxygenation did not change, and respiratory mechanics improved after the RM. RM produced a marked, though transitory, impairment of blood flow in all studied vessels. Despite prompt partial recovery, total splanchnic circulation remained reduced at 8 min after RM. This residual decrease may present a risk in conditions with markedly compromised circulatory reserves.
  
  
  CONCLUSIONS
  Recruitment maneuvers (RM) produce high intrathoracic pressures and volumes that may compromise hemodynamics. We found a marked transient impairment of hemodynamics during a RM in 10 anesthetized pigs. At 8 min after RM, blood flow remained reduced in the celiac trunk, superior mesenteric, and renal arteries, as well as in the portal vein. This residual decrease may present a risk in conditions with markedly compromised circulatory reserves.
authors.affiliation: Department of Intensive Care Medicine, University Hospital, Bern, Switzerland.
authors.forename: Silvia
authors.initials: S
authors.lastname: Nunes
authors.forename: Hans Ulrich
authors.initials: HU
authors.lastname: Rothen
authors.forename: Lukas
authors.initials: L
authors.lastname: Brander
authors.forename: Jukka
authors.initials: J
authors.lastname: Takala
authors.forename: Stephan M
authors.initials: SM
authors.lastname: Jakob
mesh_terms: D000818:Animals; D001784:Blood Gas Analysis; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D008168:Lung / Q000502:physiology*; D008297:Male; D010100:Oxygen / Q000097:blood; D011650:Pulmonary Alveoli / Q000502:physiology*; D012039:Regional Blood Flow / Q000502:physiology; D012121:Respiration, Artificial; D015656:Respiratory Mechanics / Q000502:physiology; D013152:Splanchnic Circulation / Q000502:physiology*; D013552:Swine
chemical_list: D010100:Oxygen