OBJECTIVE: Positive pressure ventilation can affect systemic haemodynamics and regional blood flow distribution with negative effects on hepatic blood flow. We hypothesized that spontaneous breathing (SB) with airway pressure release ventilation (APRV) provides better systemic and hepatic blood flow than APRV without SB. DESIGN: Animal study with a randomized cross-over design. SETTING: Animal laboratory of Bonn University Hospital. SUBJECTS: Twelve pigs with oleic-acid-induced lung injury. INTERVENTIONS: APRV with or without SB in random order. Without SB, either the upper airway pressure limit or the ventilator rate was increased to maintain constant pH and PaCO2. MEASUREMENTS AND RESULTS: Systemic haemodynamics were determined by double-indicator dilution, organ blood flow by coloured microspheres. Systemic blood flow was best during APRV with SB. During APRV with SB blood flow (ml g(-1) min(-1)) was 0.91+/-0.26 (hepatic arterial), 0.29+/-0.05 (stomach), 0.64+/-0.08 (duodenum), 0.62+/-0.10 (jejunum), 0.53+/-0.07 (ileum), 0.53+/-0.07 (colon), 0.46+/-0.09 (pancreas) and 3.59+/-0.55 (spleen). During APRV without SB applying high P(aw) it decreased to 0.13+/-0.01 (stomach), 0.37+/-0.03 (duodenum), 0.29+/-0.03 (jejunum), 0.31+/-0.05 (ileum), 0.32+/-0.03 (colon) and 0.23+/-0.04 (pancreas) p<0.01, respectively. During APRV without SB applying same Paw limits it decreased to 0.18+/-0.03 (stomach, p<0.01), 0.47+/-0.06 (duodenum, p<0.05), 0.38+/-0.05 (jejunum, p<0.01), 0.36+/-0.03 (ileum, p<0.05), 0.39+/-0.05 (colon, p<0.05), and 0.27+/-0.04 (pancreas, p<0.01). Arterial liver blood flow did not change significantly when SB was abolished (0.55+/-0.11 and 0.63+/-0.11, respectively). CONCLUSIONS: Maintaining SB during APRV was associated with better systemic and pre-portal organ blood flow. Improvement in hepatic arterial blood flow was not significant.
OBJECTIVE: Positive pressure ventilation can affect systemic haemodynamics and regional blood flow distribution with negative effects on hepatic blood flow. We hypothesized that spontaneous breathing (SB) with airway pressure release ventilation (APRV) provides better systemic and hepatic blood flow than APRV without SB. DESIGN: Animal study with a randomized cross-over design. SETTING: Animal laboratory of Bonn University Hospital. SUBJECTS: Twelve pigs with oleic-acid-induced lung injury. INTERVENTIONS: APRV with or without SB in random order. Without SB, either the upper airway pressure limit or the ventilator rate was increased to maintain constant pH and PaCO2. MEASUREMENTS AND RESULTS: Systemic haemodynamics were determined by double-indicator dilution, organ blood flow by coloured microspheres. Systemic blood flow was best during APRV with SB. During APRV with SB blood flow (ml g(-1) min(-1)) was 0.91+/-0.26 (hepatic arterial), 0.29+/-0.05 (stomach), 0.64+/-0.08 (duodenum), 0.62+/-0.10 (jejunum), 0.53+/-0.07 (ileum), 0.53+/-0.07 (colon), 0.46+/-0.09 (pancreas) and 3.59+/-0.55 (spleen). During APRV without SB applying high P(aw) it decreased to 0.13+/-0.01 (stomach), 0.37+/-0.03 (duodenum), 0.29+/-0.03 (jejunum), 0.31+/-0.05 (ileum), 0.32+/-0.03 (colon) and 0.23+/-0.04 (pancreas) p<0.01, respectively. During APRV without SB applying same Paw limits it decreased to 0.18+/-0.03 (stomach, p<0.01), 0.47+/-0.06 (duodenum, p<0.05), 0.38+/-0.05 (jejunum, p<0.01), 0.36+/-0.03 (ileum, p<0.05), 0.39+/-0.05 (colon, p<0.05), and 0.27+/-0.04 (pancreas, p<0.01). Arterial liver blood flow did not change significantly when SB was abolished (0.55+/-0.11 and 0.63+/-0.11, respectively). CONCLUSIONS: Maintaining SB during APRV was associated with better systemic and pre-portal organ blood flow. Improvement in hepatic arterial blood flow was not significant.
Authors: Tobias M Bingold; Bertram Scheller; Timo Wolf; Jens Meier; Alexander Koch; Kai Zacharowski; Peter Rosenberger; Thomas Iber Journal: Ann Intensive Care Date: 2012-03-06 Impact factor: 6.925
Authors: Sarah M McMullen; Maureen Meade; Louise Rose; Karen Burns; Sangeeta Mehta; Robert Doyle; Dietrich Henzler Journal: PLoS One Date: 2012-08-16 Impact factor: 3.240
Authors: Massimo Antonelli; Elie Azoulay; Marc Bonten; Jean Chastre; Giuseppe Citerio; Giorgio Conti; Daniel De Backer; François Lemaire; Herwig Gerlach; Johan Groeneveld; Goran Hedenstierna; Duncan Macrae; Jordi Mancebo; Salvatore M Maggiore; Alexandre Mebazaa; Philipp Metnitz; Jerôme Pugin; Jan Wernerman; Haibo Zhang Journal: Intensive Care Med Date: 2009-01-06 Impact factor: 17.440
Authors: Sumeet V Jain; Michaela Kollisch-Singule; Benjamin Sadowitz; Luke Dombert; Josh Satalin; Penny Andrews; Louis A Gatto; Gary F Nieman; Nader M Habashi Journal: Intensive Care Med Exp Date: 2016-05-20