NDLI: The effect of open lung ventilation on right ventricular and left ventricular function in lung-lavaged pigs

Content Provider	Springer Nature : BioMed Central
Author	Reis Miranda, Dinis Klompe, Lennart Cademartiri, Filippo Haitsma, Jack J Palumbo, Alessandro Takkenberg, Johanna JM Lachmann, Burkhard Bogers, Ad JJC Gommers, Diederik
Abstract	Introduction Ventilation according to the open lung concept (OLC) consists of recruitment maneuvers, followed by low tidal volume and high positive end-expiratory pressure, aiming at minimizing atelectasis. The minimization of atelectasis reduces the right ventricular (RV) afterload, but the increased intrathoracic pressures used by OLC ventilation could increase the RV afterload. We hypothesize that when atelectasis is minimized by OLC ventilation, cardiac function is not affected despite the higher mean airway pressure. Methods After repeated lung lavage, each pig (n = 10) was conventionally ventilated and was ventilated according to OLC in a randomized cross-over setting. Conventional mechanical ventilation (CMV) consisted of volume-controlled ventilation with 5 cmH2O positive end-expiratory pressure and a tidal volume of 8–10 ml/kg. No recruitment maneuvers were performed. During OLC ventilation, recruitment maneuvers were applied until PaO2/FiO2 > 60 kPa. The peak inspiratory pressure was set to obtain a tidal volume of 6–8 ml/kg. The cardiac output (CO), the RV preload, the contractility and the afterload were measured with a volumetric pulmonary artery catheter. A high-resolution computed tomography scan measured the whole lung density and left ventricular (LV) volumes. Results The RV end-systolic pressure–volume relationship, representing RV afterload, during steady-state OLC ventilation (2.7 ± 1.2 mmHg/ml) was not significantly different compared with CMV (3.6 ± 2.5 mmHg/ml). Pulmonary vascular resistance (OLC, 137 ± 49 dynes/s/cm5 versus CMV, 130 ± 34 dynes/s/cm5) was comparable between groups. OLC led to a significantly lower amount of atelectasis (13 ± 2% of the lung area) compared with CMV (52 ± 3% of the lung area). Atelectasis was not correlated with pulmonary vascular resistance or end-systolic pressure–volume relationship. The LV contractility and afterload during OLC was not significantly different compared with CMV. Compared with baseline, the LV end-diastolic volume (66 ± 4 ml) decreased significantly during OLC (56 ± 5 ml) ventilation and not during CMV (61 ± 3 ml). Also, CO was significantly lower during OLC ventilation (OLC, 4.1 ± 0.3 l/minute versus CMV, 4.9 ± 0.3 l/minute). Conclusion In this experimental study, OLC resulted in significantly improved lung aeration. Despite the use of elevated airway pressures, no evidence was found for a negative effect of OLC on RV afterload or LV afterload, which might be associated with a loss of hypoxic pulmonary vasoconstriction due to alveolar recruitment. The reductions in the CO and in the mean pulmonary artery pressure were consequences of a reduced preload.
Related Links	https://ccforum.biomedcentral.com/counter/pdf/10.1186/cc4944.pdf
Ending Page	9
Page Count	9
Starting Page	1
File Format	HTM / HTML
ISSN	13648535
DOI	10.1186/cc4944
Journal	Critical Care
Issue Number	3
Volume Number	10
Language	English
Publisher	BioMed Central
Publisher Date	2006-06-08
Access Restriction	Open
Subject Keyword	Intensive Critical Care Medicine Emergency Medicine Right Ventricular Pulmonary Capillary Wedge Pressure Recruitment Maneuver Right Ventricular Ejection Fraction Hypoxic Pulmonary Vasoconstriction
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine
Journal Impact Factor	8.8/2023
5-Year Journal Impact Factor	10.4/2023

Sl.	Authority	Responsibilities	Communication Details
1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
5	Website/Portal (Helpdesk)	Queries regarding NDLI and its services	support@ndl.gov.in
6	Contents and Copyright Issues	Queries related to content curation and copyright issues	content@ndl.gov.in
7	National Digital Library of India Club (NDLI Club)	Queries related to NDLI Club formation, support, user awareness program, seminar/symposium, collaboration, social media, promotion, and outreach	clubsupport@ndl.gov.in
8	Digital Preservation Centre (DPC)	Assistance with digitizing and archiving copyright-free printed books	dpc@ndl.gov.in
9	IDR Setup or Support	Queries related to establishment and support of Institutional Digital Repository (IDR) and IDR workshops	idr@ndl.gov.in

The effect of open lung ventilation on right ventricular and left ventricular function in lung-lavaged pigs

The right ventricle: interaction with the pulmonary circulation

Dopamine versus norepinephrine in septic shock: a meta-analysis

Impact of open lung ventilation on right ventricular outflow impedance assessed by transoesophageal echocardiography

New insights into the mechanisms involved in B-type natriuretic peptide elevation and its prognostic value in septic patients

Levosimendan in cardiac surgery

Levosimendan reduces pulmonary vascular resistance: clinical echocardiographic study

Assessment of left ventricular ejection fraction using an ultrasonic stethoscope in critically ill patients

Effect of a lung recruitment maneuver by high-frequency oscillatory ventilation in experimental acute lung injury on organ blood flow in pigs

The effect of open lung ventilation on right ventricular and left ventricular function in lung-lavaged pigs

Similar Documents

The effect of open lung ventilation on right ventricular and left ventricular function in lung-lavaged pigs

The right ventricle: interaction with the pulmonary circulation

Dopamine versus norepinephrine in septic shock: a meta-analysis

Impact of open lung ventilation on right ventricular outflow impedance assessed by transoesophageal echocardiography

New insights into the mechanisms involved in B-type natriuretic peptide elevation and its prognostic value in septic patients

Levosimendan in cardiac surgery

Levosimendan reduces pulmonary vascular resistance: clinical echocardiographic study

Assessment of left ventricular ejection fraction using an ultrasonic stethoscope in critically ill patients

Effect of a lung recruitment maneuver by high-frequency oscillatory ventilation in experimental acute lung injury on organ blood flow in pigs

The effect of open lung ventilation on right ventricular and left ventricular function in lung-lavaged pigs