Effects of a stepwise lung recruitment manoeuvre and positive end-expiratory pressure on lung compliance and arterial blood oxygenation in healthy dogs

This study was performed to evaluate the effects of a stepwise lung recruitment manoeuvre (RM) on dynamic lung compliance (Cdyn) and gas exchange in mechanically ventilated healthy dogs. Fourteen healthy adult dogs, scheduled for elective surgery in dorsal recumbency were employed. After anaesthetic induction, dogs were mechanically ventilated in a volume-controlled mode (tidal volume, VT = 10 mL/kg); positive end-expiratory pressure (PEEP) = 0 cm H2O; oxygen inspired fraction (FiO(2))= 0.4 for 30 min (baseline). The dogs were then randomly allocated into two groups, control and RM. The ventilatory mode was maintained during the whole surgical procedure in the control group without any intervention, as in general practice. The RM was performed in a pressure-controlled mode, with progressive increases of PEEP and end-inspiratory pressure of 5 cm H2O until 15 cm H2O and 30 cm H2O, respectively. After RM, PEEP was decreased to 4 cm H2O, and the ventilatory mode was returned to volume-control. Arterial blood gases and Cdyn were determined at baseline, 20 and 60 min afterwards. Student's t test and the one-way ANOVA test were employed to compare data. Cdyn increased in the RM group (183 +/- 30% and 165 +/- 24% at 20 and 60 min, respectively; P = 0.000). The baseline partial pressure of arterial oxygen to FiO(2) ratio (PaO2/FiO(2) ratio) did not change in the control group, but was higher in the RM group (527 +/- 41 mm Hg and 511 +/- 46 mm Hg at 20 and 60 min, respectively; baseline 371 +/- 34 mm Hg, P < 0.001). In conclusion, a stepwise RM followed by the use of PEEP improves Cdyn and oxygenation in mechanically ventilated healthy dogs. (C) 2012 Elsevier Ltd. All rights reserved.