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CRITICAL CARE AND TRAUMA

Changes in Splanchnic Circulation During an Alveolar Recruitment Maneuver in Healthy Porcine Lungs

From the Department of Intensive Care Medicine, University Hospital, Bern, Switzerland

Address correspondence and reprint requests to Hans U. Rothen, MD, PhD, Department of Intensive Care Medicine, University Hospital, Inselspital, CH-3010 Bern, Switzerland. Address email to hrothen{at}insel.ch

Recruitment maneuvers (RM) are advocated as a complement to mechanical ventilation during anesthesia and in acute lung injury. However, they produce high intrathoracic pressures and volumes that may compromise hemodynamics. Our aim was to analyze the effect of a RM on hemodynamics in 10 anesthetized pigs. We assessed carotid, pulmonary, femoral, and hepatic arterial pressures, hepatic and portal venous pressures, total splanchnic (celiac trunk + superior mesenteric artery), hepatic, splenic, renal, and carotid arterial flows, and portal venous flow. We recorded hemodynamics, respiratory mechanics and blood gases before and at 8 min after RM (sustained inflation to 40 cm H₂O of airway pressure lasting 20 s). Hemodynamics were also measured during RM, and at 1, 3, and 5 min after RM. All flows (P = 0.030) and arterial pressures (P 0.048) decreased during RM, whereas venous pressures increased (P = 0.030). Flows and pressures returned to 75%–109% of baseline immediately after RM. Total splanchnic, renal and portal flows remained decreased at 8 min after RM (P 0.042). Oxygenation did not change, and respiratory mechanics improved after the RM. RM produced a marked, though transitory, impairment of blood flow in all studied vessels. Despite prompt partial recovery, total splanchnic circulation remained reduced at 8 min after RM. This residual decrease may present a risk in conditions with markedly compromised circulatory reserves.

IMPLICATIONS: Recruitment maneuvers (RM) produce high intrathoracic pressures and volumes that may compromise hemodynamics. We found a marked transient impairment of hemodynamics during a RM in 10 anesthetized pigs. At 8 min after RM, blood flow remained reduced in the celiac trunk, superior mesenteric, and renal arteries, as well as in the portal vein. This residual decrease may present a risk in conditions with markedly compromised circulatory reserves.

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