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Lung recruitment manoeuvres decrease gastric mucosal blood flow in ICU patients

Introduction

The use of recruitment manoeuvres (RM) has recently been introduced into clinical practice for treatment of atelectasis during mechanical ventilation. Transient high airway pressures, such as those employed in RM, may lead to adverse general or regional circulatory effects. The aim of this study was to evaluate effects of RM on gastric mucosal blood flow, systemic oxygenation and respiratory mechanics.

Methods

Nine ICU patients with acute lung injury, age 60 ± 5, APACHE II 22 ± 3, were studied. Gastric mucosal blood flow was measured continuously with laser Doppler flowmetry (LDF). Mean arterial (MAP), central venous (CVP), oesophageal, abdominal and airway pressures were also measured continuously. Cardiac output was measured by arterial pulse contour analysis (PICCO). Three consecutive RMs separated by a 15 min pause were studied, the two first were performed with inspiratory pressure (Pinsp) 40 cmH2O, inspiratory time (Tinsp) 8 s, expiratory pressure (Pexp) 20 cmH2O and expiratory time (Texp) 2 s for 2 min. The third RMwas performed with Pinsp 50 cmH2O, Tinsp 4 s, Pexp 20 cmH2O, Texp 1 s for 2 min. Blood gas measurements were performed before, at the end of, and 3 min after each RM.

Results

When comparing values before RM1 with values obtained after RM3 preliminary data indicate that three consecutive RMs did not significantly change MAP, HR, PaO2 or dynamic compliance. There was a significant decrease in LDF, CI and a significant increase in SVRI. Three patients demonstrated a drastic increase in PaO2 during all RMs, but this increase was not sustained after the RMs were terminated.

Conclusion

Three consecutive recruitment manoeuvres decreased gastric mucosal perfusion and cardiac index without any beneficial effect on oxygenation.

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Claesson, S., Lehtipalo, S. & Winsö, O. Lung recruitment manoeuvres decrease gastric mucosal blood flow in ICU patients. Crit Care 6, P16 (2002). https://doi.org/10.1186/cc1618

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Keywords

  • Acute Lung Injury
  • Airway Pressure
  • Laser Doppler Flowmetry
  • Recruitment Manoeuvre
  • Pulse Contour