title: Cardiorespiratory effects of recruitment maneuvers and positive end expiratory pressure in an experimental context of acute lung injury and pulmonary hypertension.
abstract: BACKGROUND
  Recruitment maneuvers (RM) and positive end expiratory pressure (PEEP) are the cornerstone of the open lung strategy during ventilation, particularly during acute lung injury (ALI). However, these interventions may impact the pulmonary circulation and induce hemodynamic and respiratory effects, which in turn may be critical in case of pulmonary hypertension (PHT). We aimed to establish how ALI and PHT influence the cardiorespiratory effects of RM and PEEP.
  
  
  METHODS
  Rabbits control or with monocrotaline-induced PHT were used. Forced oscillatory airway and tissue mechanics, effective lung volume (ELV), systemic and right ventricular hemodynamics and blood gas were assessed before and after RM, during baseline and following surfactant depletion by whole lung lavage.
  
  
  RESULTS
  RM was more efficient in improving respiratory elastance and ELV in the surfactant-depleted lungs when PHT was concomitantly present. Moreover, the adverse changes in respiratory mechanics and ELV following ALI were lessened in the animals suffering from PHT.
  
  
  CONCLUSIONS
  During ventilation with open lung strategy, the role of PHT in conferring protection from the adverse respiratory consequences of ALI was evidenced. This finding advocates the safety of RM and PEEP in improving elastance and advancing lung reopening in the simultaneous presence of PHT and ALI.
authors.affiliation: Anesthesiological Investigation, University Medical Centre, University of Geneva, Geneva, Switzerland. camille.doras@unige.ch.
authors.forename: Camille
authors.initials: C
authors.lastname: Doras
authors.affiliation: Department of Anesthesiology, Hospital Foch, University Versailles Saint-Quentin en Yvelines, Suresnes, France. m.leguen@hopital-foch.org.
authors.forename: Morgan
authors.initials: M
authors.lastname: Le Guen
authors.affiliation: Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary. petak.ferenc@med.u-szeged.hu.
authors.forename: Ferenc
authors.initials: F
authors.lastname: Peták
authors.affiliation: Anesthesiological Investigation, University Medical Centre, University of Geneva, Geneva, Switzerland. walid.habre@hcuge.ch.|Pediatric Anesthesia Unit, Geneva Children's Hospital, Rue Willy Donzé 6, 1205, Geneva, Switzerland. walid.habre@hcuge.ch.
authors.forename: Walid
authors.initials: W
authors.lastname: Habre
mesh_terms: D055371:Acute Lung Injury / Q000503:physiopathology* / Q000628:therapy; D000818:Animals; D004195:Disease Models, Animal; D005260:Female; D006976:Hypertension, Pulmonary / Q000503:physiopathology* / Q000628:therapy; D008168:Lung / Q000503:physiopathology; D011175:Positive-Pressure Respiration / Q000379:methods*; D011659:Pulmonary Gas Exchange; D011817:Rabbits; D015656:Respiratory Mechanics