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Heart-lung interactions with different ventilatory settings during acute lung injury and hypovolaemia: an experimental study.
da Silva Ramos, F J; de Oliveira, E M; Park, M; Schettino, G P P; Azevedo, L C P.
Afiliação
  • da Silva Ramos FJ; Intensive Care and Anaesthesiology Research Laboratory, Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
Br J Anaesth ; 106(3): 394-402, 2011 Mar.
Article em En | MEDLINE | ID: mdl-21278154
BACKGROUND: The functional haemodynamic variables pulse pressure variation (PPV), stroke volume variation (SVV), and systolic pressure variation (SPV) are widely used to assess haemodynamic status. However, it is not known how these perform during acute lung injury (ALI). This study evaluated the effects of different ventilatory strategies on haemodynamic parameters in pigs with ALI during normovolaemia and hypovolaemia. METHODS: Eight anaesthetized Agroceres pigs [40 (1.9) kg] were instrumented with pulmonary artery, PiCCO, and arterial catheters and ventilated. Three ventilatory settings were randomly assigned for 10 min each: tidal volume (VT) 15 ml kg(-1) and PEEP 5 cm H(2)O, VT 8 ml kg(-1) and PEEP 13 cm H(2)O, or VT 6 ml kg(-1) and PEEP 13 cm H(2)O. Data were collected at each setting at baseline, after ALI (lung lavage+Tween 1.5%), and ALI with hypovolaemia (haemorrhage to 30% of estimated blood volume). RESULTS: At baseline, high VT increased PPV, SVV, and SPV (P<0.05 for all). During ALI, high VT significantly increased PPV and SVV [(P = 0.002 and P = 0.008) respectively.]. After ALI with hypovolaemia, ventilation at VT 6 ml kg(-1) and PEEP 13 cm H(2)O decreased the accuracy of functional haemodynamic variables to predict hypovolaemia, with the exception of PPV (area under the curve 0.875). The parameters obtained by PiCCO were less influenced by ventilatory changes. CONCLUSIONS: VT is the ventilatory parameter which influences functional haemodynamics the most. During ventilation with low VT and high PEEP, most functional variables are less able to accurately predict hypovolaemia secondary to haemorrhage, with the exception of PPV.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Respiração com Pressão Positiva / Hipovolemia / Lesão Pulmonar Aguda Tipo de estudo: Diagnostic_studies / Etiology_studies / Prognostic_studies Limite: Animals Idioma: En Revista: Br J Anaesth Ano de publicação: 2011 Tipo de documento: Article País de afiliação: Brasil País de publicação: Reino Unido

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Respiração com Pressão Positiva / Hipovolemia / Lesão Pulmonar Aguda Tipo de estudo: Diagnostic_studies / Etiology_studies / Prognostic_studies Limite: Animals Idioma: En Revista: Br J Anaesth Ano de publicação: 2011 Tipo de documento: Article País de afiliação: Brasil País de publicação: Reino Unido