title: Lung recruitment manoeuvres do not cause haemodynamic instability or oxidative stress but improve oxygenation and lung mechanics in a newborn animal model: an observational study.
abstract: BACKGROUND
  Lung recruitment manoeuvres in neonates during anaesthesia are not performed routinely due to concerns about causing barotrauma, haemodynamic instability and oxidative stress.
  
  
  OBJECTIVE
  To assess the influence of recruitment manoeuvres and positive end-expiratory pressure (PEEP) on haemodynamics, oxidative stress, oxygenation and lung mechanics.
  
  
  METHODS
  A prospective experimental study.
  
  
  METHODS
  Experimental Unit, La Paz University Hospital, Madrid, Spain.
  
  
  METHODS
  Eight newborn piglets (<48 h) with healthy lungs under general anaesthesia.
  
  
  METHODS
  The recruitment manoeuvres in pressure-controlled ventilation (PCV) were performed along with a constant driving pressure of 15 cmH2O. After the recruitment manoeuvres, PEEP was reduced in a stepwise fashion to find the maximal dynamic compliance step (maxCDyn-PEEP). Blood oxidative stress biomarkers (lipid peroxidation products, protein carbonyls, total glutathione, oxidised glutathione, reduced glutathione and activity of glutathione peroxidase) were analysed.
  
  
  METHODS
  Haemodynamic parameters, arterial partial pressure of oxygen (paO2), tidal volume (Vt), dynamic compliance (Cdyn) and oxidative stress biomarkers were measured.
  
  
  RESULTS
  The recruitment manoeuvres did not induce barotrauma. Haemodynamic instability was not detected either in the maximum pressure step (overdistension step 5) or during the entire process. No substantial differences were observed in blood oxidative stress parameters analysed as compared with their baseline values (with 0 PEEP) or the values obtained 180 min after the onset of the recruitment manoeuvres (optimal PEEP). Significant maximal values were achieved in step 14 with an increase in paO2 (32.43 ± 8.48 vs. 40.39 ± 15.66 kPa; P = 0.037), Vt (47.75 ± 13.59 vs. 73.87 ± 13.56 ml; P = 0.006) and Cdyn (2.50 ± 0.64 vs. 4.75 ± 0.88 ml cmH2O; P < 0.001). Maximal dynamic compliance step (maxCdyn-PEEP) was 2 cmH2O.
  
  
  CONCLUSIONS
  Recruitment manoeuvres in PCV with a constant driving pressure are a well tolerated open-lung strategy in a healthy-lung neonatal animal model under general anaesthesia. The recruitment manoeuvres improve oxygenation parameters and lung mechanics and do not cause barotrauma, haemodynamic instability or oxidative stress.
authors: From the Anaesthesia Department, Universitary General Hospital of Ciudad Real (AMDLO), Anaesthesia and Critical Care Department, Puerta de Hierro University Hospital, Majadahonda Experimental Unit, La Paz University Hospital, Madrid (JGF), Paediatric Intensive Care Unit, Department of Paediatrics, Reina Sofia University Hospital, Maimónides Institute for Biomedical Research of Cordoba (IMIBIC), University of Cordoba (FJLC, MGC, MJDLTA, IIDLR, JLPN), Unit of Methodology in Investigation, Instituto Maimo[Combining Acute Accent]nides de Investigacio[Combining Acute Accent]n Biome[Combining Acute Accent]dica de Co[Combining Acute Accent]rdoba, Cordoba, Spain (IMIBIC) (MCMV).
authors: Agustín Mendiola
authors: AM
authors: de la Osa
authors: Javier
authors: J
authors: Garcia-Fernandez
authors: Francisco J
authors: FJ
authors: Llorente-Cantarero
authors: Mercedes
authors: M
authors: Gil-Campos
authors: María C
authors: MC
authors: Muñoz-Villanueva
authors: María J
authors: MJ
authors: De la Torre Aguilar
authors: Ignacio Ibarra
authors: II
authors: de la Rosa
authors: Juan L
authors: JL
authors: Pérez-Navero
mesh_terms: D000768:Anesthesia, General / Q000379:methods; D000818:Animals; D000831:Animals, Newborn; D001469:Barotrauma / Q000209:etiology; D015415:Biomarkers / Q000378:metabolism; D001784:Blood Gas Analysis; D006439:Hemodynamics / Q000502:physiology; D008168:Lung / Q000378:metabolism*; D023421:Models, Animal; D018384:Oxidative Stress / Q000502:physiology*; D010100:Oxygen / Q000378:metabolism*; D011175:Positive-Pressure Respiration / Q000379:methods*; D013030:Spain; D013552:Swine; D013990:Tidal Volume / Q000502:physiology
chemical_list: D015415:Biomarkers; D010100:Oxygen