Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-10T17:39:55.116Z Has data issue: false hasContentIssue false
  • English
  • Français

Effects of pressure- and volume-controlled inverse ratio ventilation on haemodynamic variables, intracranial pressure and cerebral perfusion pressure in rabbits: a model of subarachnoid haemorrhage under isoflurane anaesthesia

Published online by Cambridge University Press:  11 July 2005

A. Taplu ,
N. Gökmen ,
S. Erbayraktar ,
B. Sade ,
N. Erkan ,
K. Karadibak  and
A. Arkan
A. Taplu
Affiliation:
Dokuz Eylül University School of Medicine, Department of Anaesthesiology, Izmir, Turkey
N. Gökmen
Affiliation:
Dokuz Eylül University School of Medicine, Department of Anaesthesiology, Izmir, Turkey
S. Erbayraktar
Affiliation:
Dokuz Eylül University School of Medicine, Department of Anaesthesiology, Izmir, Turkey
B. Sade
Affiliation:
Dokuz Eylül University School of Medicine, Department of Anaesthesiology, Izmir, Turkey
N. Erkan
Affiliation:
Dokuz Eylül University School of Medicine, Department of Anaesthesiology, Izmir, Turkey
K. Karadibak
Affiliation:
Dokuz Eylül University School of Medicine, Department of Anaesthesiology, Izmir, Turkey
A. Arkan
Affiliation:
Dokuz Eylül University School of Medicine, Department of Anaesthesiology, Izmir, Turkey
Get access

Extract

Summary

Background and objective: An inverse I : E ratio (inspiratory time > expiratory time) may have benefits in patients suffering trauma who requiring lung ventilation. However, this application may be deleterious if there is concomitant head injury. We aimed to determine the physiological effects of pressure- and volume-controlled modes of inverse ratio (I : E = 2 : 1) ventilation of the lungs, while maintaining normocapnia, in a rabbit model of raised intracranial pressure (ICP).

Methods: New Zealand White rabbits were anaesthetized with isoflurane and a tracheostomy was performed. Subarachnoid haemorrhage was simulated in two groups by injecting blood into the cisterna magna. Groups 1 and 2 (n = 6, each), controls, were compared with Groups 3 and 4 (n = 6, each) with the simulated subarachnoid haemorrhage. Each ventilation mode was used with an I : E ratio of 2 : 1 for 30 min. Mean arterial pressure (MAP), ICP, cerebral perfusion pressure (CPP), mean airway pressure (PAW) and arterial blood-gas status were measured.

Results: Both modes increased mean PAW (P < 0.02). This increase was greater with the volume-controlled mode (P < 0.02). The baseline value averaged 5.8 ± 0.4 and 5.6 ± 0.3 mmHg in Groups 3 and 4, respectively, and increased to 7.8 ± 0.3 and 10.8 ± 0.4 mmHg. Inducing subarachnoid haemorrhage increased ICP and MAP (P < 0.02). Baseline ICPs were 10.3 ± 0.5 and 10.3 ± 0.4 mmHg in Groups 1 and 2, respectively, whereas they were 25.4 ± 1.2 and 25.8 ± 0.8 mmHg in Groups 3 and 4. However, ICP, MAP and CPP did not differ significantly according to the mode.

Conclusions: An already raised ICP was altered by the application of induced mean PAW increases as a consequence of inverse ratio ventilation of the lungs with normocapnia.

Keywords

NERVOUS SYSTEM PHYSIOLOGY, cerebrospinal fluid pressure, intracranial pressureRABBITSRESPIRATION, ARTIFICIAL, intermittent positive-pressure ventilation, positive-pressure respiration
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 9 , September 2003 , pp. 690 - 696
Copyright
© 2003 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Burchiel KJ, Steege TD, Wyler AR. ICP changes in brain-injured patients requiring positive end-expiratory pressure ventilation. Neurosurgery 1981; 8: 443–449.Google Scholar
Hormann C, Mohsenipour I, Gottardis M, Benzer A. Response of cerebrospinal fluid pressure to continuous positive airway pressure in volunteers. Anesth Analg 1994; 78: 54–57.Google Scholar
Guerci AD, Shi AY, Levin H, Tsitlik J, Weisfeldt ML, Chandra N. Transmission of intrathoracic pressure to the intracranial space during cardiopulmonary resuscitation in dogs. Circ Res 1985; 56: 20–30.Google Scholar
Bouma GJ, Muizelaar JP, Bandoh K, Marmarou A. Blood pressure and ICP–volume dynamics in severe head injury: relationship with cerebral blood flow. J Neurosurg 1992; 77: 15–19.Google Scholar
Clarke JP. The effects of inverse ratio ventilation on ICP: a preliminary report. Intensive Care Med 1997; 23: 106–109.Google Scholar
Vollmer DG, Hongo K, Ogawa H, Tsukahara T, Kassell NF. A study of the effectiveness of the iron-chelating agent deferoxamine as vasospasm prophylaxis in a rabbit model of subarachnoid hemorrhage. Neurosurgery 1999; 28: 27–32.Google Scholar
Arthur AS, Fergus AH, Lanzino G, Mathys J, Kassell NF, Lee KS. Systemic administration of the iron chelator deferiprone attenuates subarachnoid hemorrhage-induced cerebral vasospasm in the rabbit. Neurosurgery 1997; 41: 1385–1391.Google Scholar
Donegan J. Physiology and metabolism of the brain and spinal cord. In: Newfield P, Cottreli JE, eds. Neuroanesthesia: Handbook of Clinical and Physiologic Essentials. San Francisco, USA: Little Brown, 1991: 3–29.
Kuroda Y, Murakami M, Tsuruta J, Murakawa T, Sakabe T. Blood flow velocity of middle cerebral artery during prolonged anesthesia with halothane, isoflurane, and sevoflurane in humans. Anesthesiology 1997; 87: 527–532.Google Scholar
Todd MM, Drummond JC. A comparison of the cerebrovascular and metabolic effects of halothane and isoflurane in the cat. Anesthesiology 1984; 60: 276–282.Google Scholar
Chan K, Abraham E. Effects of inverse ratio ventilation on cardiorespiratory parameters in severe respiratory failure. Chest 1992; 102: 1556–1561.Google Scholar
Mang H, Kacmarek RM, Ritz R, Wilson RS, Kimball WP. Cardiorespiratory effects of volume- and pressure-controlled ventilation at various I/E ratios in an acute lung injury model. Am J Respir Crit Care Med 1995; 151: 731–736.Google Scholar
Ludwigs U, Klingstedt C, Baehrendtz S, Hedenstierna G. A comparison of pressure- and volume-controlled ventilation at different inspiratory to expiratory ratios. Acta Anaesthesiol Scand 1997; 41: 71–77.Google Scholar
Lessard MR, Guerot E, Lorino H, Lemaire F, Brochard L. Effects of pressure-controlled with different I : E ratios versus volume-controlled ventilation on respiratory mechanics, gas exchange, and hemodynamics in patients with adult respiratory distress syndrome. Anesthesiology 1994; 80: 983–991.Google Scholar
Ludwigs U, Philip A, Robertson B, Hedenstierna G. Pulmonary epithelial permeability. An animal study of inverse ratio ventilation and conventional mechanical ventilation. Chest 1996; 110: 486–493.Google Scholar
Ludwigs U, Klingstedt C, Baehrendtz S, Wegenius G, Hedenstierna G. A functional and morphologic analysis of pressure-controlled inverse ratio ventilation in oleic acid-induced lung injury. Chest 1994; 106: 925–931.Google Scholar
Feldman Z, Robertson CS, Contant CF, Gopinath SP, Grossman RG. Positive end expiratory pressure reduces intracranial compliance in the rabbit. J Neurosurg Anesthesiol 1997; 9: 175–179.Google Scholar
Abraham E, Yoshihara G. Cardiorespiratory effects of pressure controlled ventilation in severe respiratory failure. Chest 1990; 98: 1445–1449.Google Scholar
Abraham E, Yoshihara G. Cardiorespiratory effects of pressure controlled inverse ratio ventilation in severe respiratory failure Chest 1989; 96: 1356–1359.Google Scholar