Comparison of Recruitment Manoeuvres in Ventilated Sheep with Acute Respiratory Distress Syndrome

Background Recruitment manoeuvres are widely used in clinical practice to open the lung and prevent lung injury by derecruitment, although the evidence is still discussed. In this study two different recruitment manoeuvres were compared to no recruitment manoeuvres (control) in ventilated sheep with...

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Bibliographic Details
Published in:Lung 2013-02, Vol.191 (1), p.77-86
Main Authors: Engel, Monique, Nowacki, Relana M. E., Reiss, Lucy K., Uhlig, Stefan, Willems, Coen H. M. P., Kloosterboer, Nico, van Iwaarden, J. Freek, Sewing, Alide C. P., Seehase, Matthias, Lambermont, Verena A. C., Collins, Jennifer J. P., Zimmermann, Luc J. I., Vos, Gijs D., Kramer, Boris W.
Format: Article
Language:English
Subjects:
Acute respiratory distress syndrome
Animals
Artificial respiration
Blood pressure
Blood Pressure - physiology
Bronchoalveolar Lavage - adverse effects
Care and treatment
Disease Models, Animal
Female
Health aspects
Lung Injury - pathology
Lung Injury - physiopathology
Medicine
Medicine & Public Health
Pneumology/Respiratory System
Positive-Pressure Respiration
Prospective Studies
Pulmonary Gas Exchange - physiology
Respiration, Artificial - methods
Respiratory diseases
Respiratory Distress Syndrome, Adult - etiology
Respiratory Distress Syndrome, Adult - physiopathology
Sheep
Ventilation
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Summary:Background Recruitment manoeuvres are widely used in clinical practice to open the lung and prevent lung injury by derecruitment, although the evidence is still discussed. In this study two different recruitment manoeuvres were compared to no recruitment manoeuvres (control) in ventilated sheep with acute respiratory distress syndrome (ARDS), induced by lung lavage. Methods We performed a prospective, randomised study in 26 ventilated sheep with ARDS, to evaluate the effect of two different recruitment manoeuvres on gas exchange, blood pressure and lung injury. The two different recruitment manoeuvres, the high pressure recruitment manoeuvre (HPRM), with high peak pressure, and the smooth and moderate recruitment manoeuvre (SMRM), with lower peak pressure, were compared to controls (no recruitment) after disconnection. Oxygenation index and ventilation efficacy index were calculated to evaluate gas exchange. Lung injury was assessed by inflammatory response in broncho-alveolar lavage fluid (BALF) and blood and histology of the lung. Results Oxygenation index improved significantly after both recruitment manoeuvres compared with controls, but no significant difference was found between the recruitment manoeuvres. Blood pressure decreased after HPRM but not after SMRM. HPRM induced a higher number of total cells and more neutrophils in the BALF. In the histology of the lung, mean alveolar size was increased in the dorsocranial region of the lung of SMRM compared to controls. Conclusion Recruitment manoeuvres improved oxygenation, but SMRM was superior, with respect to hemodynamics and pulmonary inflammation, in ventilated sheep suffering from ARDS induced by lung lavage.
ISSN:0341-2040
1432-1750
DOI:10.1007/s00408-012-9428-2