Effect of position, nitric oxide, and almitrine on lung perfusion in a porcine model of acute lung injury

Service de Réanimation Médicale et Assistance Respiratoire, Lyon 69004; Equipe d'Accueil Universitaire 1896, Université Claude Bernard Lyon I, 69008 Lyon; Centre d'Exploration et de Recherche Médicales par Emission de Positons, Hôpital Neuro-Cardiologique, 69003 Lyon, France In a porcine model of oleic acid-induced lung injury, the effects of inhaled nitric oxide (iNO) and intravenous almitrine bismesylate (ivALM), which enhances the hypoxic pulmonary vasoconstriction on the distribution of regional pulmonary blood flow (PBF), were assessed. After injection of 0.12 ml/kg oleic acid, 20 anesthetized and mechanically ventilated piglets [weight of 25 ± 2.6 (SD) kg] were randomly divided into four groups: supine position, prone position, and 10 ppm iNO for 40 min followed by 4 µg · kg 1 · min 1 ivALM for 40 min in supine position and in prone position. PBF was measured with positron emission tomography and H 2 15 O. The redistribution of PBF was studied on a pixel-by-pixel basis. Positron emission tomography scans were performed before and then 120, 160, and 200 min after injury. With prone position alone, although PBF remained prevalent in the dorsal regions it was significantly redistributed toward the ventral regions ( P