title: Slow moderate pressure recruitment maneuver minimizes negative circulatory and lung mechanic side effects: evaluation of recruitment maneuvers using electric impedance tomography.
abstract: OBJECTIVE
  To evaluate the efficacy of different lung recruitment maneuvers using electric impedance tomography.
  
  
  METHODS
  Experimental study in animal model of acute lung injury in an animal research laboratory.
  
  
  METHODS
  Fourteen pigs with saline lavage induced lung injury.
  
  
  METHODS
  Lung volume, regional ventilation distribution, gas exchange, and hemodynamics were monitored during three different recruitment procedures: (a) vital capacity maneuver to an inspiratory pressure of 40 cmH2O (ViCM), (b) pressure-controlled recruitment maneuver with peak pressure 40 and PEEP 20 cmH2O, both maneuvers repeated three times for 30 s (PCRM), and (c) a slow recruitment with PEEP elevation to 15 cmH2O with end inspiratory pauses for 7 s twice per minute over 15 min (SLRM).
  
  
  RESULTS
  Improvement in lung volume, compliance, and gas exchange were similar in all three procedures 15 min after recruitment. Ventilation in dorsal regions of the lungs increased by 60% as a result of increased regional compliance. During PCRM compliance decreased by 50% in the ventral region. Cardiac output decreased by 63+/-4% during ViCM, 44+/-2% during PCRM, and 21+/-3% during SLRM.
  
  
  CONCLUSIONS
  In a lavage model of acute lung injury alveolar recruitment can be achieved with a slow lower pressure recruitment maneuver with less circulatory depression and negative lung mechanic side effects than with higher pressure recruitment maneuvers. With electric impedance tomography it was possible to monitor lung volume changes continuously.
authors.affiliation: Department of Anesthesia and Intensive Care, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden. helena.odenstedt@vgregion.se
authors.forename: Helena
authors.initials: H
authors.lastname: Odenstedt
authors.forename: Sophie
authors.initials: S
authors.lastname: Lindgren
authors.forename: Cecilia
authors.initials: C
authors.lastname: Olegård
authors.forename: Karin
authors.initials: K
authors.lastname: Erlandsson
authors.forename: Sven
authors.initials: S
authors.lastname: Lethvall
authors.forename: Anders
authors.initials: A
authors.lastname: Aneman
authors.forename: Ola
authors.initials: O
authors.lastname: Stenqvist
authors.forename: Stefan
authors.initials: S
authors.lastname: Lundin
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D017097:Electric Impedance; D006439:Hemodynamics; D008170:Lung Compliance; D008176:Lung Volume Measurements / Q000295:instrumentation*; D011175:Positive-Pressure Respiration / Q000379:methods*; D001261:Pulmonary Atelectasis / Q000517:prevention & control; D011659:Pulmonary Gas Exchange; D012123:Pulmonary Ventilation; D011897:Random Allocation; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000628:therapy*; D013552:Swine; D014054:Tomography / Q000379:methods*