Cargando…

Effect of PEEP and I:E ratio on cerebral oxygenation in ARDS: an experimental study in anesthetized rabbit

BACKGROUND: Although PEEP and inversed I:E ratio have been shown to improve gas exchange in ARDS, both can adversely affect systemic hemodynamics and cerebral perfusion. The goal of this study was to assess how changes in PEEP and I:E ratio affect systemic and cerebral oxygenation and perfusion in n...

Descripción completa

Detalles Bibliográficos
Autores principales: Lovisari, Federica, Fodor, Gergely H., Peták, Ferenc, Habre, Walid, Bayat, Sam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6582519/
https://www.ncbi.nlm.nih.gov/pubmed/31216981
http://dx.doi.org/10.1186/s12871-019-0782-y
_version_ 1783428339017449472
author Lovisari, Federica
Fodor, Gergely H.
Peták, Ferenc
Habre, Walid
Bayat, Sam
author_facet Lovisari, Federica
Fodor, Gergely H.
Peták, Ferenc
Habre, Walid
Bayat, Sam
author_sort Lovisari, Federica
collection PubMed
description BACKGROUND: Although PEEP and inversed I:E ratio have been shown to improve gas exchange in ARDS, both can adversely affect systemic hemodynamics and cerebral perfusion. The goal of this study was to assess how changes in PEEP and I:E ratio affect systemic and cerebral oxygenation and perfusion in normal and injured lung. METHODS: Eight anesthetized Chinchilla-Bastard rabbits were ventilated at baseline with pressure-regulated volume control mode, V(T) = 6 ml/kg, PEEP = 6 cmH(2)O, FIO(2) = 0.4; respiratory rate set for ETCO(2) = 5.5%, and I:E = 1:2, 1:1 or 2:1 in random order. Ultrasonic carotid artery flow (CF), arterial (PaO(2)), jugular venous blood gases and near infrared spectroscopic cerebral oxygenation (∆HBO(2)) were recorded for each experimental condition. After induced lung injury, the animals were ventilated with PEEP = 9 followed by 6 cmH(2)O. RESULTS: At baseline, inverse-ratio ventilation (IRV) significantly reduced cerebral oxygenation (∆O(2)HB; − 27 at 1:2; − 15 at 1:1 vs. 0.27 μmol/L at 2:1; p < 0.05), due to a significant reduction in mean arterial pressure and CF without modifying gas exchange. In injured lung, IRV improved gas exchange but decreased cerebral perfusion without affecting brain oxygenation. The higher PEEP level, however, improved PaO(2) (67.5 ± 19.3 vs. 42.2 ± 8.4, p < 0.05), resulting in an improved ∆HBO(2) (− 13.8 ± 14.7 vs. –43.5 ± 21.3, p < 0.05), despite a drop in CF. CONCLUSIONS: Our data suggest that unlike moderate PEEP, IRV is not effective in improving brain oxygenation in ARDS. In normal lung, IRV had a deleterious effect on brain oxygenation, which is relevant in anesthetized patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12871-019-0782-y) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-6582519
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-65825192019-06-26 Effect of PEEP and I:E ratio on cerebral oxygenation in ARDS: an experimental study in anesthetized rabbit Lovisari, Federica Fodor, Gergely H. Peták, Ferenc Habre, Walid Bayat, Sam BMC Anesthesiol Research Article BACKGROUND: Although PEEP and inversed I:E ratio have been shown to improve gas exchange in ARDS, both can adversely affect systemic hemodynamics and cerebral perfusion. The goal of this study was to assess how changes in PEEP and I:E ratio affect systemic and cerebral oxygenation and perfusion in normal and injured lung. METHODS: Eight anesthetized Chinchilla-Bastard rabbits were ventilated at baseline with pressure-regulated volume control mode, V(T) = 6 ml/kg, PEEP = 6 cmH(2)O, FIO(2) = 0.4; respiratory rate set for ETCO(2) = 5.5%, and I:E = 1:2, 1:1 or 2:1 in random order. Ultrasonic carotid artery flow (CF), arterial (PaO(2)), jugular venous blood gases and near infrared spectroscopic cerebral oxygenation (∆HBO(2)) were recorded for each experimental condition. After induced lung injury, the animals were ventilated with PEEP = 9 followed by 6 cmH(2)O. RESULTS: At baseline, inverse-ratio ventilation (IRV) significantly reduced cerebral oxygenation (∆O(2)HB; − 27 at 1:2; − 15 at 1:1 vs. 0.27 μmol/L at 2:1; p < 0.05), due to a significant reduction in mean arterial pressure and CF without modifying gas exchange. In injured lung, IRV improved gas exchange but decreased cerebral perfusion without affecting brain oxygenation. The higher PEEP level, however, improved PaO(2) (67.5 ± 19.3 vs. 42.2 ± 8.4, p < 0.05), resulting in an improved ∆HBO(2) (− 13.8 ± 14.7 vs. –43.5 ± 21.3, p < 0.05), despite a drop in CF. CONCLUSIONS: Our data suggest that unlike moderate PEEP, IRV is not effective in improving brain oxygenation in ARDS. In normal lung, IRV had a deleterious effect on brain oxygenation, which is relevant in anesthetized patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12871-019-0782-y) contains supplementary material, which is available to authorized users. BioMed Central 2019-06-19 /pmc/articles/PMC6582519/ /pubmed/31216981 http://dx.doi.org/10.1186/s12871-019-0782-y Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Lovisari, Federica
Fodor, Gergely H.
Peták, Ferenc
Habre, Walid
Bayat, Sam
Effect of PEEP and I:E ratio on cerebral oxygenation in ARDS: an experimental study in anesthetized rabbit
title Effect of PEEP and I:E ratio on cerebral oxygenation in ARDS: an experimental study in anesthetized rabbit
title_full Effect of PEEP and I:E ratio on cerebral oxygenation in ARDS: an experimental study in anesthetized rabbit
title_fullStr Effect of PEEP and I:E ratio on cerebral oxygenation in ARDS: an experimental study in anesthetized rabbit
title_full_unstemmed Effect of PEEP and I:E ratio on cerebral oxygenation in ARDS: an experimental study in anesthetized rabbit
title_short Effect of PEEP and I:E ratio on cerebral oxygenation in ARDS: an experimental study in anesthetized rabbit
title_sort effect of peep and i:e ratio on cerebral oxygenation in ards: an experimental study in anesthetized rabbit
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6582519/
https://www.ncbi.nlm.nih.gov/pubmed/31216981
http://dx.doi.org/10.1186/s12871-019-0782-y
work_keys_str_mv AT lovisarifederica effectofpeepandieratiooncerebraloxygenationinardsanexperimentalstudyinanesthetizedrabbit
AT fodorgergelyh effectofpeepandieratiooncerebraloxygenationinardsanexperimentalstudyinanesthetizedrabbit
AT petakferenc effectofpeepandieratiooncerebraloxygenationinardsanexperimentalstudyinanesthetizedrabbit
AT habrewalid effectofpeepandieratiooncerebraloxygenationinardsanexperimentalstudyinanesthetizedrabbit
AT bayatsam effectofpeepandieratiooncerebraloxygenationinardsanexperimentalstudyinanesthetizedrabbit