The role of fluid resuscitation in alveolar microcirculation disorders caused by high PEEP in mechanical ventilation

doi:10.3877/cma.j.issn.2096-1537.2019.01.005

Abstract

Abstract:

Objective

To reveal the changes of alveolar microcirculation in mechanical ventilation with high PEEP and the influence of fluid resuscitation on alveolar microcirculation.

Methods

This study was carried in 15 healthy, adult mongrel dogs in Beijing, to observe the breathing, systemic circulation and alveolar microcirculation respectively in baseline(PEEP 5 cmH₂O), high PEEP (MAP dropped more than 20 mmHg, before resuscitation) and high PEEP after fluid resuscitation. The alveolar microcirculation was observed by the SDF(sidestream dark-field, SDF), record videos and then analyzed by software of AVA3.2 off-line, comparisons of experimental data in different conditions was used the Wilcoxon test.

Results

CVP elevated and CO dropped in mechanical ventilation with high PEEP, total vascular density (TVDa, P=0.036), perfused vessel density (PVDa, P=0.002), proportion of perfused vessels (PPVa, P=0.003) and microvascular flow index (MFIa, P=0.002) of alveolar microcirculation were significant reduced, the capillary density surrounding the alveolar decline was not obvious(TVDs, P=0.319). The alveolar microcirculation is not improved after the fluid resuscitation.

Conclusion

Alveolar microcirculation is significantly worsed in mechanical ventilation with high PEEP and fluid resuscitation can not improve the alveolar microcirculation disorders.

Key words: PEEP, Alveolar, Microcirculation, Fluid resuscitation

Qinghe Hu, Yun Long, Xu Wang, Runshi Zhou. The role of fluid resuscitation in alveolar microcirculation disorders caused by high PEEP in mechanical ventilation[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2019, 05(01): 20-26.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2019.01.005

https://icu.cma-cmc.com.cn/EN/Y2019/V05/I01/20

Figures/Tables 4

References 10

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时间段	HR（次/min）	MAP（mmHg）	CVP（mmHg）	Gap（mmHg）	ScvO₂	Lac（mmol/L）	CO（L/min）	Pplat	PEEP（cmH₂O）
基线	83.057±32.854	119.400±19.617	7.154±3.185	4.421±2.286	0.687±0.143	2.135±1.804	2.547±0.587	9.733±1.709	5.000±0.000
高PEEP	111.400±24.257	85.400±27.176	12.846±3.105	6.879±5.140	0.473±0.206	2.757±1.761	1.447±0.549	31.857±5.081	23.067±3.105
液体复苏	109.429±25.849	117.500±21.707	13.750±3.467	3.442±4.254	0.591±0.190	2.823±2.273	2.173±0.329	32.143±5.395	23.286±3.099
t₁值	-2.458	-2.989	-3.451	-1.451	-2.712	-1.634	-3.092	-4.682	-5.098
P₁值	0.014	0.003	0.001	0.147	0.007	0.102	0.002	0	0
t₂值	-2.358	-0.699	-3.502	-0.983	-1.08	-1.628	-1.104	-4.6	-5.057
P₂值	0.018	0.485	0	0.326	0.28	0.104	0.269	0	0
t₃值	-0.306	-2.99	-0.63	-1.573	-1.235	-0.17	-2.783	-0.263	-0.267
P₃值	0.706	0.003	0.528	0.116	0.217	0.865	0.005	0.792	0.789

时间段	HR（次/min）	MAP（mmHg）	CVP（mmHg）	Gap（mmHg）	ScvO₂	Lac（mmol/L）	CO（L/min）	Pplat	PEEP（cmH₂O）
基线	83.057±32.854	119.400±19.617	7.154±3.185	4.421±2.286	0.687±0.143	2.135±1.804	2.547±0.587	9.733±1.709	5.000±0.000
高PEEP	111.400±24.257	85.400±27.176	12.846±3.105	6.879±5.140	0.473±0.206	2.757±1.761	1.447±0.549	31.857±5.081	23.067±3.105
液体复苏	109.429±25.849	117.500±21.707	13.750±3.467	3.442±4.254	0.591±0.190	2.823±2.273	2.173±0.329	32.143±5.395	23.286±3.099
t₁值	-2.458	-2.989	-3.451	-1.451	-2.712	-1.634	-3.092	-4.682	-5.098
P₁值	0.014	0.003	0.001	0.147	0.007	0.102	0.002	0	0
t₂值	-2.358	-0.699	-3.502	-0.983	-1.08	-1.628	-1.104	-4.6	-5.057
P₂值	0.018	0.485	0	0.326	0.28	0.104	0.269	0	0
t₃值	-0.306	-2.99	-0.63	-1.573	-1.235	-0.17	-2.783	-0.263	-0.267
P₃值	0.706	0.003	0.528	0.116	0.217	0.865	0.005	0.792	0.789

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