Hemodynamic effects of PEEP in a porcine model of HCl-induced mild acute lung injury.
BACKGROUND
Positive end-expiratory pressure (PEEP) and sustained inspiratory insufflations (SI) during acute lung injury (ALI) are suggested to improve oxygenation and respiratory mechanics. We aimed to investigate the hemodynamic effects of PEEP with and without alveolar recruiting maneuver in a mild ALI model induced by inhalation of hydrochloric acid.


METHODS
Thirty-two pigs were randomly allocated into four groups (Control-PEEP, Control-SI, ALI-PEEP and ALI-SI). ALI was induced by intratracheal instillation of hydrochloric acid. PEEP values were progressively increased and decreased from 5, 10, 15 and 20 cmH2O in all groups. Three SIs maneuvers of 30 cmH2O for 20 s were applied to the assignable groups between each PEEP level. Transesophageal echocardiography (TEE), global hemodynamics, oxygenation indexes and gastric tonometry were measured 5 min after the maneuvers had been concluded and at each established value of PEEP (5, 10, 15 and 20 cmH2O).


RESULTS
The cardiac index, ejection fraction and end-diastolic volume of right ventricle were significantly (P < 0.001) decreased with PEEP in both Control and ALI groups. Left ventricle echocardiography showed a significant decrease in end-diastolic volume at 20 cmH2O of PEEP (P < 0.001). SIs did not exert any significant hemodynamic effects either early (after 5 min) or late (after 3 h).


CONCLUSIONS
In a mild ALI model induced by inhalation of hydrochloric acid, significant hemodynamic impairment characterized by cardiac function deterioration occurred during PEEP increment, but SI, probably due to low applied values (30 cmH2O), did not exert further negative hemodynamic effects. PEEP should be used cautiously in ALI caused by acid gastric content inhalation.
Marumo
C K
CK
Laboratory of Medical Investigation LIM08, Faculdade de Medicina, Universidade de São Paulo, Brazil.
Otsuki
D A
DA
Fantoni
D T
DT
Margarido
C B
CB
Ambrósio
A M
AM
Pelosi
P
P
Auler
J O C
JO
D055371:Acute Lung Injury / Q000097:blood / Q000139:chemically induced / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D000818:Animals; D004195:Disease Models, Animal; D017548:Echocardiography, Transesophageal; D006439:Hemodynamics; D006851:Hydrochloric Acid / Q000633:toxicity; D007327:Insufflation; D008168:Lung / Q000473:pathology; D008170:Lung Compliance; D008297:Male; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011175:Positive-Pressure Respiration; D011897:Random Allocation; D053120:Respiratory Aspiration; D016037:Single-Blind Method; D013318:Stroke Volume; D034421:Sus scrofa; D014655:Vascular Resistance
D006851:Hydrochloric Acid; D010100:Oxygen