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Regional blood flows are affected differently by PEEP when the abdomen is open or closed: an experimental rabbit model

[L'influence de la PEP sur le débit sanguin régional est différente selon que l'abdomen est fermé ou ouvert : un modèle expérimental chez le lapin]

Jean-Yves Lefrant, MD PhD^*, Jean-Marie Juan, MD, Pascal Bruelle, MD MSc^*, Roland Demaria, MD PhD, Robert Cohendy, MD PhD, Guy Aya, MD MSc, Marie-Claire Oliva-Lauraire, Pascale Peray, MD PhD, Emmanuelle Robert, PhD, Jean-Emmanuel de La Coussaye, MD PhD^*, Jean-Jacques Eledjam, MD PhD^* and Michel Dauzat, MD PhD

^* From the Department of Anesthesiology, Critical Care Medicine, and Emergency, Nîmes University Hospital;
the Laboratory of Cardio-Vascular Physiology and Anesthesiology, Montpellier-Nîmes Faculty of Medicine; and
the Department of Medical Information, Biostatistics, and Epidemiology, Nîmes University Hospital, Nîmes, France.

Dr. Michel Dauzat, Montpellier-Nîmes Faculty of Medicine, Avenue Kennedy, 30907 Nîmes cedex, France. Phone: +33 (0)4 66 23 49 73; Fax: +33 (0)4 66 23 55 38; E-mail: dauzat{at}sc.univ-montp1.fr

Objective: The study of induced circulatory changes requires simultaneous assessment of multiple regional circulations because of interactions and compensatory mechanisms. Positive end expiratory pressure mechanical ventilation (PEEP) is known to cause marked, and potentially deleterious, cardiovascular changes. Our aim was to use a comprehensive approach to assess PEEP-induced circulatory changes in open vs closed abdomen animals.

Material and methods: In the anesthetized rabbit, we used implantable Doppler micro-probes to measure blood flow simultaneously in the ascending aorta, inferior vena cava, portal vein, hepatic artery, common carotid artery, and renal artery. We studied spontaneously breathing animals (Group A), and open (Group B) and closed abdomen (Group C) animals mechanically ventilated at 0 (ZEEP) and 12 cm H₂O PEEP.

Results: In Group A, all biological and hemodynamic variables remained unchanged for three hours at the end of the surgical procedure. In Groups B and C, ZEEP produced no significant hemodynamic change. PEEP induced a decrease in carotid, hepatic, and renal artery blood flow in Groups B and C, a decrease in heart rate and mean arterial blood pressure in Group B, and a decrease in aorta blood flow in Group C.

Conclusions: These experimental results demonstrate the usefulness of the comprehensive approach of circulatory changes, and confirm that PEEP may have deleterious effects on regional blood flow, even without significant change in cardiac output, especially when the abdomen is open.