Effects of descending positive end-expiratory pressure on lung mechanics and aeration in healthy anaesthetized piglets

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dc.contributor.authorCarvalho, A. R.en
dc.contributor.authorJandre, F. C.en
dc.contributor.authorPino, A. V.en
dc.contributor.authorBozza, F. A.en
dc.contributor.authorSalluh, J. I.en
dc.contributor.authorRodrigues, R.en
dc.contributor.authorSoares, J. H.en
dc.contributor.authorGiannella-Neto, A.en
dc.coverage.spatialEnglanden
dc.date.accessioned2017-02-02T16:13:43Zen
dc.date.available2017-02-02T16:13:43Zen
dc.date.issued2006en
dc.description.abstractINTRODUCTION: Atelectasis and distal airway closure are common clinical entities of general anaesthesia. These two phenomena are expected to reduce the ventilation of dependent lung regions and represent major causes of arterial oxygenation impairment in anaesthetic conditions. In the present study, the behavior of the elastance of the respiratory system (Ers), as well as the lung aeration assessed by CT-scan, was evaluated during a descendent positive end-expiratory pressure (PEEP) titration. This work sought to evaluate the potential usefulness of the Ers monitoring to set the PEEP in order to prevent tidal recruitment and hyperinflation of healthy lungs under general anaesthesia. METHODS: PEEP titration (from 16 to 0 cmH2O, with a tidal volume of 8 ml/kg) was performed, and at each PEEP, helical CT-scans were obtained during end-expiratory and end-inspiratory pauses in six healthy, anaesthetized and paralyzed piglets. The distribution of lung compartments (hyperinflated (HA), normally- (NA), poorly- (PA), and non-aerated areas (N)) was determined and the tidal re-aeration was calculated as the difference between end-expiratory and end-inspiratory PA and NA areas. Similarly, the tidal hyperinflation was obtained as the difference between end-inspiratory and end-expiratory HA. The Ers was estimated on a breath-by-breath basis from the equation of motion of the respiratory system during all PEEP titration with the least squares method. RESULTS: HA decreased throughout PEEP descent from PEEP 16 cmH2O to ZEEP (ranges from 24-62% to 1-7% at end-expiratory and from 44-73% to 4-17% at end-inspiratory pauses) whereas NA areas increased (30-66% to 72-83% at end-expiratory and from 19-48% to 73-77% at end-inspiratory pauses). From 16 to 8 cmH2O, Ers decreased with a correspondent reduction in tidal hyperinflation. A flat minimum of Ers was observed from 8 to 4 cmH2O. For PEEP below 4 cmH2O, Ers increased associated with a rise in tidal re-aeration and a flat maximum of the NA areas. CONCLUSION: In healthy piglets under a descending PEEP protocol, the PEEP at minimum Ers presented a compromise between maximizing NA areas and minimizing tidal re-aeration and hyperinflation. High levels of PEEP, greater than 8 cmH2O, reduced tidal re-aeration but enlarged hyperinflation with a concomitant decrease in normally aerated areas.en
dc.description.versionPublished versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.doihttps://doi.org/10.1186/cc5030en
dc.identifier.eissn1466-609Xen
dc.identifier.issue4en
dc.identifier.urihttp://hdl.handle.net/10919/74901en
dc.identifier.volume10en
dc.language.isoenen
dc.relation.urihttp://www.ncbi.nlm.nih.gov/pubmed/16925814en
dc.rightsIn Copyrighten
dc.rights.urihttp://rightsstatements.org/vocab/InC/1.0/en
dc.subjectAnesthesia, Generalen
dc.subjectAnimalsen
dc.subjectAnimals, Newbornen
dc.subjectFemaleen
dc.subjectLungen
dc.subjectLung Complianceen
dc.subjectPositive-Pressure Respirationen
dc.subjectPulmonary Gas Exchangeen
dc.subjectRespiratory Mechanicsen
dc.subjectSwineen
dc.titleEffects of descending positive end-expiratory pressure on lung mechanics and aeration in healthy anaesthetized pigletsen
dc.title.serialCritical Careen
dc.typeArticle - Refereeden
dc.type.dcmitypeTexten
dc.type.otherComparative Studyen
dc.type.otherResearch Support, Non-U.S. Gov'ten
pubs.organisational-group/Virginia Techen
pubs.organisational-group/Virginia Tech/All T&R Facultyen
pubs.organisational-group/Virginia Tech/Veterinary Medicineen
pubs.organisational-group/Virginia Tech/Veterinary Medicine/CVM T&R Facultyen
pubs.organisational-group/Virginia Tech/Veterinary Medicine/Small Animal Clinical Sciencesen

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