Cardiac index and oxygen delivery during low and high tidal volume ventilation strategies in patients with acute respiratory distress syndrome: a crossover randomized clinical trial

Natalini, Giuseppe; Minelli, Cosetta; Rosanò, Antonio; Ferretti, Pierluigi; Militano, Carmine Rocco; Feo, Carlo De; Bernardini, Achille

doi:10.1186/cc12825

Cited by 4 publications

(4 citation statements)

References 28 publications

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“…Our results confirm recent data on the interaction of lung protective mechanical ventilation and moderate respiratory acidosis on systemic hemodynamics [ 10 ] and extend these findings to the regional capillary and nutritional circulation. In our experimental animals limiting airway and intrathoracic pressures did not result in an increased preload as intrathoracic blood volume, central venous and pulmonary capillary wedge pressure remained unchanged.…”

Section: Discussionsupporting

confidence: 92%

“…Actually, ARDS and the strategy of mechanical ventilation not only affects the right heart and pulmonary vascular system [ 6 ] but also systemic blood flow [ 7 – 9 ]. Natalini et al recently demonstrated that lung protective ventilation and moderate hypercapnia resulted in an improvement in cardiac output (CO) and a decrease in oxygen extraction ratio in ARDS patients [ 10 ]. Extending these results of improved systemic hemodynamics to the regional vascular beds would be of great interest.…”

Section: Introductionmentioning

confidence: 99%

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Effects of lung protective mechanical ventilation associated with permissive respiratory acidosis on regional extra-pulmonary blood flow in experimental ARDS

2017

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BackgroundLung protective mechanical ventilation with limited peak inspiratory pressure has been shown to affect cardiac output in patients with ARDS. However, little is known about the impact of lung protective mechanical ventilation on regional perfusion, especially when associated with moderate permissive respiratory acidosis. We hypothesized that lung protective mechanical ventilation with limited peak inspiratory pressure and moderate respiratory acidosis results in an increased cardiac output but unequal distribution of blood flow to the different organs of pigs with oleic-acid induced ARDS.MethodsTwelve pigs were enrolled, 3 died during instrumentation and induction of lung injury. Thus, 9 animals received pressure controlled mechanical ventilation with a PEEP of 5 cmH2O and limited peak inspiratory pressure (17 ± 4 cmH2O) versus increased peak inspiratory pressure (23 ± 6 cmH2O) in a crossover-randomized design and were analyzed. The sequence of limited versus increased peak inspiratory pressure was randomized using sealed envelopes. Systemic and regional hemodynamics were determined by double indicator dilution technique and colored microspheres, respectively. The paired student t–test and the Wilcoxon test were used to compare normally and not normally distributed data, respectively.ResultsMechanical ventilation with limited inspiratory pressure resulted in moderate hypercapnia and respiratory acidosis (PaCO2 71 ± 12 vs. 46 ± 9 mmHg, and pH 7.27 ± 0.05 vs. 7.38 ± 0.04, p < 0.001, respectively), increased cardiac output (140 ± 32 vs. 110 ± 22 ml/min/kg, p<0.05) and regional blood flow in the myocardium, brain and spinal cord, adrenal and thyroid glands, the mucosal layers of the esophagus and jejunum, the muscularis layers of the esophagus and duodenum, and the gall and urinary bladders. Perfusion of kidneys, pancreas, spleen, hepatic arterial bed, and the mucosal and muscularis blood flow to the other evaluated intestinal regions remained unchanged.ConclusionsIn this porcine model of ARDS mechanical ventilation with limited peak inspiratory pressure resulting in moderate respiratory acidosis was associated with an increase in cardiac output. However, the better systemic blood flow was not uniformly directed to the different organs. This observation may be of clinical interest in patients, e.g. with cardiac, renal and cerebral pathologies.Electronic supplementary materialThe online version of this article (10.1186/s12871-017-0439-7) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Effects of lung protective mechanical ventilation associated with permissive respiratory acidosis on regional extra-pulmonary blood flow in experimental ARDS

2017

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“…Although HCA has a direct negative inotropic effect, the indirect hypercapnia-mediated sympatho-adrenal effects of increased heart rate and decreased afterload lead to a net increase in cardiac output [ 45 ]. It is somewhat reassuring to note that HCA can increase tissue oxygen delivery in moderate to severe ARDS, as in this study [ 44 ].…”

Section: Protective Lung Ventilation – How Low Should We Gosupporting

confidence: 59%

“…Another randomized crossover study in 2013 addressed this very point. Natalini and colleagues [ 44 ] ventilated 16 patients with ARDS for 30 minutes with either low (6 mL/kg) or high (12 mL/kg) tidal volume ventilation and then obtained hemodynamic measurements, including cardiac index and oxygen delivery. Cardiac index and oxygen delivery index were increased with low compared with high tidal volume ventilation, whereas oxygen extraction ratio decreased.…”

Section: Protective Lung Ventilation – How Low Should We Gomentioning

confidence: 99%

Year in review 2013: Critical Care- respirology

Curley

Slutsky

2014

Crit Care

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This review documents important progress made in 2013 in the field of critical care respirology, in particular with regard to acute respiratory failure and acute respiratory distress syndrome. Twenty-five original articles published in the respirology and critical care sections of Critical Care are discussed in the following categories: pre-clinical studies, protective lung ventilation – how low can we go, non-invasive ventilation for respiratory failure, diagnosis and prognosis in acute respiratory distress syndrome and respiratory failure, and promising interventions for acute respiratory distress syndrome.

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Applicability of stroke volume variation in patients of a general intensive care unit: a longitudinal observational study

Mair

Tschirdewahn

Götz

et al. 2016

J Clin Monit Comput

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Sinus rhythm (SR) and controlled mechanical ventilation (CV) are mandatory for the applicability of respiratory changes of the arterial curve such as stroke volume variation (SVV) to predict fluid-responsiveness. Furthermore, several secondary limitations including tidal volumes <8 mL/kg and SVV-values within the "gray zone" of 9-13% impair prediction of fluid-responsiveness by SVV. Therefore, we investigated the prevalence of these four conditions in general ICU-patients. This longitudinal observational study analyzed a prospectively maintained haemodynamic database including 4801 transpulmonary thermodilution and pulse contour analysis measurements of 278 patients (APACHE-II 21.0 ± 7.4). The main underlying diseases were cirrhosis (32%), sepsis (28%), and ARDS (17%). The prevalence of SR and CV was only 19.4% (54/278) in the first measurements (primary endpoint), 18.8% (902/4801) in all measurements and 26.5% (9/34) in measurements with MAP < 65 mmHg and CI < 2.5 L/min/m and vasopressor therapy. In 69.1% (192/278) of the first measurements and in 65.9% (3165/4801) of all measurements the patients had SR but did not have CV. In 1.8% (5/278) of the first measurements and in 2.5% (119/4801) of all measurements the patients had CV but lacked SR. In 9.7% (27/278) of the first measurements and in 12.8% (615/4801) of all measurements the patients did neither have SR nor CV. Only 20 of 278 (7.2%) of the first measurements and 8.2% of all measurements fulfilled both major criteria (CV, SR) and both minor criteria for the applicability of SVV. The applicability of SVV in ICU-patients is limited due to the absence of mandatory criteria during the majority of measurements.

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Cardiac index and oxygen delivery during low and high tidal volume ventilation strategies in patients with acute respiratory distress syndrome: a crossover randomized clinical trial

Cited by 4 publications

References 28 publications

Effects of lung protective mechanical ventilation associated with permissive respiratory acidosis on regional extra-pulmonary blood flow in experimental ARDS

Effects of lung protective mechanical ventilation associated with permissive respiratory acidosis on regional extra-pulmonary blood flow in experimental ARDS

Year in review 2013: Critical Care- respirology

Applicability of stroke volume variation in patients of a general intensive care unit: a longitudinal observational study

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