Positive end-expiratory pressure in pressure-controlled ventilation improves ventilatory and oxygenation parameters during laparoscopic cholecystectomy

2009 ◽  
Vol 24 (5) ◽  
pp. 1099-1103 ◽  
Author(s):  
Ji Young Kim ◽  
Cheung Soo Shin ◽  
Hong Soon Kim ◽  
Wol Sun Jung ◽  
Hyun Jeong Kwak
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Positive End Expiratory Pressure ◽  
Controlled Ventilation ◽  
Pressure Controlled Ventilation ◽  
Pressure Controlled

scholarly journals Effect of mechanical pressure-controlled ventilation in patients with disturbed respiratory function during laparoscopic cholecystectomy

2013 ◽  
Vol 70 (1) ◽  
pp. 9-15
Author(s):  
Maja Surbatovic ◽  
Zoran Vesic ◽  
Dragan Djordjevic ◽  
Sonja Radakovic ◽  
Snjezana Zeba ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Respiratory Function ◽  
Respiratory Diseases ◽  
Positive Pressure ◽  
Time Interval ◽  
Time Intervals ◽  
Controlled Ventilation ◽  
Arterial Blood ◽  
Pressure Controlled Ventilation ◽  
Pressure Controlled

Background/Aim: Laparoscopic cholecystectomy is considered to be the gold standard for laparoscopic surgical procedures. In ASA III patients with concomitant respiratory diseases, however, creation of pneumoperitoneum and the position of patients during surgery exert additional negative effect on intraoperative respiratory function, thus making a higher challenge for the anesthesiologist than for the surgeon. The aim of this study was to compare the effect of intermittent positive pressure ventilation (IPPV) and pressure controlled ventilation (PCV) during general anesthesia on respiratory function in ASA III patients submitted to laparoscopic cholecystectomy. Methods. The study included 60 patients randomized into two groups depending on the mode of ventilation: IPPV or PCV. Respiratory volume (VT), peak inspiratory pressure (PIP), compliance (C), end-tidal CO2 pressure (PETCO2), oxygen saturation (SpO2), partial pressures of O2, CO2 (PaO2 and PaCO2) and pH of arterial blood were recorded within four time intervals. Results. There were no statistically significant differences in VT, SpO2, PaO2, PaCO2 and pH values neither within nor between the two groups. In time interval t1 there were no statistically significant differences in PIP, C, PETCO2 values between the IPPV and the PCV group. But, in the next three time intervals there was a difference in PIP, C, and PETCO2 values between the two groups which ranged from statistically significant to highly significant; PIP was lower, C and PETCO2 were higher in the PCV group. Conclusion. Pressure controlled ventilation better maintains stability regarding intraoperative ventilatory parameters in ASA III patients with concomitant respiratory diseases during laparoscopic cholecystectomy.

scholarly journals Combined Ventilation Of Two Subjects With A Single Mechanical Ventilator Using A New Medical Device: An In Vitro Study

2021 ◽  
Author(s):  
Ignacio Lugones ◽  
Matias Ramos ◽  
Maria Fernanda Biancolini ◽  
Roberto Eduardo Orofino Giambastiani
Keyword(s):  
Tidal Volume ◽  
Lung Compliance ◽  
Positive End Expiratory Pressure ◽  
Controlled Ventilation ◽  
Pressure Controlled Ventilation ◽  
Volume Controlled Ventilation ◽  
Ventilation Modes ◽  
The Subject ◽  
Volume Controlled ◽  
Pressure Controlled

INTRODUCTION: The SARS-CoV2 pandemic has created a sudden lack of ventilators. DuplicAR® is a novel device that allows simultaneous and independent ventilation of two subjects with a single ventilator. The aims of this study are: a) to determine the efficacy of DuplicAR® to independently regulate the peak and positive-end expiratory pressures in each subject, both under pressure-controlled ventilation and volume-controlled ventilation, and b) to determine the ventilation mode in which DuplicAR® presents the best performance and safety. MATERIALS AND METHODS: Two test lungs are connected to a single ventilator using DuplicAR®. Three experimental stages are established: 1) two identical subjects, 2) two subjects with the same weight but different lung compliance, and 3) two subjects with different weight and lung compliance. In each stage, the test lungs are ventilated in two ventilation modes. The positive-end expiratory pressure requirements are increased successively in one of the subjects. The goal is to achieve a tidal volume of 7 ml/kg for each subject in all different stages through manipulation of the ventilator and the DuplicAR® controllers. RESULTS: DuplicAR® allows adequate ventilation of two subjects with different weight and/or lung compliance and/or PEEP requirements. This is achieved by adjusting the total tidal volume for both subjects (in volume-controlled ventilation) or the highest peak pressure needed (in pressure-controlled ventilation) along with the basal positive-end expiratory pressure on the ventilator, and simultaneously manipulating the DuplicAR® controllers to decrease the tidal volume or the peak pressure in the subject that needs less and/or to increase the positive-end expiratory pressure in the subject that needs more. While ventilatory goals can be achieved in any of the ventilation modes, DuplicAR® performs better in pressure-controlled ventilation, as changes experienced in the variables of one subject do not modify the other one. CONCLUSIONS: DuplicAR® is an effective tool to manage the peak inspiratory pressure and the positive-end expiratory pressure independently in two subjects connected to a single ventilator. The driving pressure can be adjusted to meet the requirements of subjects with different weight and lung compliance. Pressure-controlled ventilation has advantages over volume-controlled ventilation and is therefore the recommended ventilation mode.

Effect of Ventilatory Settings on Accuracy of Cardiac Output Measurement Using Partial CO2Rebreathing

2002 ◽  
Vol 96 (1) ◽  
pp. 96-102 ◽  
Author(s):  
Kazuya Tachibana ◽  
Hideaki Imanaka ◽  
Hiroshi Miyano ◽  
Muneyuki Takeuchi ◽  
Keiji Kumon ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Tidal Volume ◽  
Positive End Expiratory Pressure ◽  
Limits Of Agreement ◽  
Ventilatory Mode ◽  
Controlled Ventilation ◽  
Pressure Controlled Ventilation ◽  
Volume Controlled Ventilation ◽  
Volume Controlled ◽  
Pressure Controlled

Background Recently, a new device has been developed to measure cardiac output noninvasively using partial carbon dioxide (CO(2)) rebreathing. Because this technique uses CO(2) rebreathing, the authors suspected that ventilatory settings, such as tidal volume and ventilatory mode, would affect its accuracy: they conducted this study to investigate which parameters affect the accuracy of the measurement. Methods The authors enrolled 25 pharmacologically paralyzed adult post-cardiac surgery patients. They applied six ventilatory settings in random order: (1) volume-controlled ventilation with inspired tidal volume (V(T)) of 12 ml/kg; (2) volume-controlled ventilation with V(T) of 6 ml/kg; (3) pressure-controlled ventilation with V(T) of 12 ml/kg; (4) pressure-controlled ventilation with V(T) of 6 ml/kg; (5) inspired oxygen fraction of 1.0; and (6) high positive end-expiratory pressure. Then, they changed the maximum or minimum length of rebreathing loop with V(T) set at 12 ml/kg. After establishing steady-state conditions (15 min), they measured cardiac output using CO(2) rebreathing and thermodilution via a pulmonary artery catheter. Finally, they repeated the measurements during pressure support ventilation, when the patients had restored spontaneous breathing. The correlation between two methods was evaluated with linear regression and Bland-Altman analysis. Results When VT was set at 12 ml/kg, cardiac output with the CO(2) rebreathing technique correlated moderately with that measured by thermodilution (y = 1.02x, R = 0.63; bias, 0.28 l/min; limits of agreement, -1.78 to +2.34 l/min), regardless of ventilatory mode, oxygen concentration, or positive end-expiratory pressure. However, at a lower VT of 6 ml/kg, the CO(2) rebreathing technique underestimated cardiac out-put compared with thermodilution (y = 0.70x; R = 0.70; bias, -1.66 l/min; limits of agreement, -3.90 to +0.58 l/min). When the loop was fully retracted, the CO(2) rebreathing technique overestimated cardiac output. Conclusions Although cardiac output was underreported at small VT values, cardiac output measured by the CO(2) rebreathing technique correlates fairly with that measured by the thermodilution method.

scholarly journals Combined Ventilation of Two Subjects with a Single Mechanical Ventilator Using a New Medical Device: An In Vitro Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Ignacio Lugones ◽  
Matías Ramos ◽  
María Fernanda Biancolini ◽  
Roberto Orofino Giambastiani
Keyword(s):  
Tidal Volume ◽  
Ventilation Mode ◽  
Positive End Expiratory Pressure ◽  
Controlled Ventilation ◽  
Pressure Controlled Ventilation ◽  
Volume Controlled Ventilation ◽  
Ventilation Modes ◽  
The Subject ◽  
Volume Controlled ◽  
Pressure Controlled

Introduction. The SARS-CoV-2 pandemic has created a sudden lack of ventilators. DuplicARⓇ is a novel device that allows simultaneous and independent ventilation of two subjects with a single ventilator. The aims of this study are (a) to determine the efficacy of DuplicARⓇ to independently regulate the peak and positive-end expiratory pressures in each subject, both under pressure-controlled ventilation and volume-controlled ventilation and (b) to determine the ventilation mode in which DuplicARⓇ presents the best performance and safety. Materials and Methods. Two test lungs are connected to a single ventilator using DuplicARⓇ. Three experimental stages are established: (1) two identical subjects, (2) two subjects with the same weight but different lung compliance, and (3) two subjects with different weights and lung compliances. In each stage, the test lungs are ventilated in two ventilation modes. The positive-end expiratory pressure requirements are increased successively in one of the subjects. The goal is to achieve a tidal volume of 7 ml/kg for each subject in all different stages through manipulation of the ventilator and the DuplicARⓇ controllers. Results. DuplicARⓇ allows adequate ventilation of two subjects with different weights and/or lung compliances and/or PEEP requirements. This is achieved by adjusting the total tidal volume for both subjects (in volume-controlled ventilation) or the highest peak pressure needed (in pressure-controlled ventilation) along with the basal positive-end expiratory pressure on the ventilator and simultaneously manipulating the DuplicARⓇ controllers to decrease the tidal volume or the peak pressure in the subject that needs less and/or to increase the positive-end expiratory pressure in the subject that needs more. While ventilatory goals can be achieved in any of the ventilation modes, DuplicARⓇ performs better in pressure-controlled ventilation, as changes experienced in the variables of one subject do not modify the other one. Conclusions. DuplicARⓇ is an effective tool to manage the peak inspiratory pressure and the positive-end expiratory pressure independently in two subjects connected to a single ventilator. The driving pressure can be adjusted to meet the requirements of subjects with different weights and lung compliances. Pressure-controlled ventilation has advantages over volume-controlled ventilation and is therefore the recommended ventilation mode.

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