The effects of intraoperative lung protective ventilation with positive end-expiratory pressure on blood loss during hepatic resection surgery

2016 ◽  
Vol 33 (4) ◽  
pp. 292-298 ◽  
Author(s):  
Arthur Neuschwander ◽  
Emmanuel Futier ◽  
Samir Jaber ◽  
Bruno Pereira ◽  
Mathilde Eurin ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hepatic Resection ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Positive End Expiratory Pressure

scholarly journals Patients with uninjured lungs may also benefit from lung-protective ventilator settings

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 2040 ◽  
Author(s):  
Roger Alencar ◽  
Vittorio D'Angelo ◽  
Rachel Carmona ◽  
Marcus J Schultz ◽  
Ary Serpa Neto
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Positive End Expiratory Pressure ◽  
Ventilator Induced Lung Injury ◽  
Life Saving ◽  
Indispensable Tool ◽  
Ventilator Settings

Although mechanical ventilation is a life-saving strategy in critically ill patients and an indispensable tool in patients under general anesthesia for surgery, it also acts as a double-edged sword. Indeed, ventilation is increasingly recognized as a potentially dangerous intrusion that has the potential to harm lungs, in a condition known as ‘ventilator-induced lung injury’ (VILI). So-called ‘lung-protective’ ventilator settings aiming at prevention of VILI have been shown to improve outcomes in patients with acute respiratory distress syndrome (ARDS), and, over the last few years, there has been increasing interest in possible benefit of lung-protective ventilation in patients under ventilation for reasons other than ARDS. Patients without ARDS could benefit from tidal volume reduction during mechanical ventilation. However, it is uncertain whether higher levels of positive end-expiratory pressure could benefit these patients as well. Finally, recent evidence suggests that patients without ARDS should receive low driving pressures during ventilation.

Positive End-Expiratory Pressure Setting in Adults with ALI and ARDS

2018 ◽  
pp. 147-151
Author(s):  
J. Aaron Scott ◽  
Vivek Moitra
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Acute Lung Injury ◽  
Organ Failure ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Positive End Expiratory Pressure ◽  
Pressure Setting ◽  
Significant Difference ◽  
Secondary Outcomes

The ExPress Trial examined the role of a positive end-expiratory pressure (PEEP) strategy targeting increased alveolar recruitment versus minimal alveolar distension in the treatment of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Although lung protective ventilation in ALI and ARDS showed significant mortality benefit, the optimal PEEP strategy was unclear. The primary outcome of the study was 28 day mortality. Secondary outcomes included ventilator-free days, organ failure–free days, and barotrauma-related adverse events. Even though there was no significant difference in mortality between the two arms of the study, a significant difference was identified in ventilator-free days and organ failure–free days, which supported an increased recruitment PEEP strategy in the ALI/ARDS population and encouraged further examination.

scholarly journals Ventilator settings and outcome of respiratory failure in paraquat-induced pulmonary injury

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Seyedehparvin Khazraei ◽  
Sayed Mahdi Marashi ◽  
Hossein Sanaei-Zadeh
Keyword(s):  
Respiratory Failure ◽  
Acute Phase ◽  
Analytical Study ◽  
Life Support ◽  
Protective Ventilation ◽  
Teaching Hospitals ◽  
Lung Protective Ventilation ◽  
Pulmonary Injury ◽  
Positive End Expiratory Pressure ◽  
Novel Treatments

Abstract Paraquat is a nonselective contact herbicide that has significant importance in clinical toxicology due to its high mortality rate. The cause of mortality in the acute phase of poisoning is a multi-organ failure while in the sub-acute phase is alveolar injury and lung fibrosis. The aim of this study was to evaluate the advantages and drawbacks of mechanical ventilation (MV) in paraquat-induced pulmonary injury and its consequential respiratory failure (PIPI-CRF). This retrospective descriptive analytical study was done to investigate the outcome of patients who had developed PIPI-CRF and underwent conventional treatments with invasive MV in three teaching hospitals in Shiraz, Iran, from March 2010 to February 2015. In total, 44 patients (mean age of 27.9 ± 9.98 years) had undergone MV due to PIPI-CRF. None of the patients had a successful wean off from the ventilator. Although all the patients’ were on aggressive life support and full efforts to resuscitate were carried out in case of cardiac arrest, all of them expired. We suggest that in the case of conventional treatment of paraquat poisoning, only noninvasive ventilation should be applied. However, considering the chance of patient’s survival performing novel treatments, such as extracorporeal membrane oxygenation (ECMO), lung protective ventilation with optimal positive end-expiratory pressure (PEEP) could be applied only in such circumstances.

scholarly journals Comparative analysis of changes in the lungs of experimental animals’ induced conventional and lung protective ventilation

2018 ◽  
Vol 69 (1) ◽  
pp. 771
Author(s):  
N. VIDENOVIC ◽  
J. MLADENOVIC ◽  
V. VIDENOVIC ◽  
R. ZDRAVKOVIC
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Control Group ◽  
Histological Structure ◽  
Positive End Expiratory Pressure ◽  
Acid Base ◽  
Acid Base Status ◽  
The Impact

Mechanical ventilation has long been the leader in the treatment of critically ill and injured patients in an intensive care unit. The aim of this study was to examine the impact of the application of positive end-expiratory pressure on histopathological findings and on the parameters of ventilation, oxygenation and acid-base status. The experimental study included 42 animals (piglets), which were divided into of tree groups, each containing 14. The animals of the control group (conventional ventilation) were ventilated with the tidal volume of 10-15 mL/kg. Tidal volume of 6 mL/kg was applied in the low tidal ventilation group, whereas the ventilation strategy in the lung protective ventilation group meant the application of a tidal volume of 6 mL/kg and the 7 mbar of positive end-expiratory pressure. Mechanical ventilation in each animal lasted for 4 hours. After conducting mechanical ventilation, samples were taken from the lung tissue, which were sent for histopathological examination. The parameters of ventilation, oxygenation and acid-base status were measured after each hour’s duration of mechanical ventilation. Application of positive end-expiratory pressure 5-10 mbar during mechanical ventilation is a safe and useful method which is not followed by the occurrence of significant abnormalities in the structure of the ventilated lung. However, a low tidal volume without positive end-expiratory pressure causes significant changes in the histological structure of healthy lungs. Positive end-expiratory pressure keeps the alveoli open throughout the respiratory cycle which allows the lungs to maintain homeostasis in terms of adequate ventilation, oxygenation and acid-base status.

scholarly journals Case Report: Respiratory Management With a 47-Day ECMO Support for a Critical Patient With COVID-19

2021 ◽  
Vol 8 ◽  
Author(s):  
Wen Xu ◽  
Ruoming Tan ◽  
Jie Huang ◽  
Shuai Qin ◽  
Jing Wu ◽  
...  
Keyword(s):  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Positive End Expiratory Pressure ◽  
Barthel Index Score ◽  
Complete Case ◽  
Respiratory Management ◽  
Critical Patients

This paper reports a complete case of severe acute respiratory distress syndrome (ARDS) caused by coronavirus disease 2019 (COVID-19), who presented with rapid deterioration of oxygenation during hospitalization despite escalating high-flow nasal cannulation to invasive mechanical ventilation. After inefficacy with lung-protective ventilation, positive end-expiratory pressure (PEEP) titration, prone position, we administered extracorporeal membrane oxygenation (ECMO) as a salvage respiratory support with ultra-protective ventilation for 47 days and finally discharged the patient home with a good quality of life with a Barthel Index Score of 100 after 76 days of hospitalization. The purpose of this paper is to provide a clinical reference for the management of ECMO and respiratory strategy of critical patients with COVID-19-related ARDS.

scholarly journals Mechanical Ventilation with Dynamic Compliance-Guided Positive End-Expiratory Pressure in Laparoscopic Surgery with Trendelenburg Positioning: A Eandomised Controlled Study

2021 ◽  
Author(s):  
Yun Wang ◽  
Huijuan Wang ◽  
Xiaoli Wang ◽  
Hong Wang ◽  
Shitong Li ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Laparoscopic Surgery ◽  
Right Ventricular ◽  
Right Ventricular Function ◽  
Dynamic Compliance ◽  
Protective Ventilation ◽  
Trial Registration ◽  
Lung Protective Ventilation ◽  
Positive End Expiratory Pressure ◽  
Group I

Abstract BACKGROUND: The intraoperative cardiorespiratory effect of ventilation with individualised positive end-expiratory pressure guided by dynamic compliance (Cdyn) remains undefined. We investigated whether individualised protective ventilation would protect the heart and lung more efficiently than standard protective ventilation during abdominal laparoscopic surgery with Trendelenburg positioning.METHODS: Forty patients undergoing abdominal laparoscopic surgery were randomly divided into two groups: Group T (titrimetric PEEP) and Group I (intentional PEEP, 5 cmH2O). Parameters of right ventricular function were measured via transoesophageal echocardiography, including tricuspid annular plane systolic excursion (TAPSE), early filling-to-late filling ratio of the right ventricle, and right ventricular end-diastolic area/left ventricular end-diastolic area (RVEDA/LVEDA) ratio. Cdyn, driving pressure (∆P), ratio of dead space to tidal volume (VD/VT), and partial pressure of arterial oxygen to inspiratory oxygen fraction (PF) ratio were measured during mechanical ventilation.RESULTS: The RVEDA/LVEDA ratio in all patients increased significantly at T2 compared with T0, but there were no significant differences in TAPSE or E/A ratio between groups during the whole procedure (P>0.05). Cdyn, ∆P, and VD/VT ratios in Group T were significantly improved compared to those in Group I at T2 (P<0.05). There was no significant difference in the PF ratio between groups (P>0.05).CONCLUSIONS: Intraoperative lung-protective ventilation with Cdyn-guided PEEP improved Cdyn, ∆P, and VD/VT ratio without obvious side effects on right ventricular function compared to standard protective ventilation during laparoscopic surgery with Trendelenburg positioning, which suggests that it is a circulation-friendly way to titrate PEEP for intraoperative lung protective ventilation.TRIAL REGISTRATION: Trial registration date: 13/09/2020; Trial registration number: ChiCTR2000038212.

scholarly journals Driving pressure y mortalidad en el síndrome de distrés respiratorio agudo

2019 ◽  
Vol 11 (8) ◽  
pp. 2
Author(s):  
Isabel de la Calle Gil ◽  
Rosalía Navarro Casado ◽  
Raquel García Álvarez
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Protective Ventilation ◽  
Alveolar Recruitment ◽  
Driving Pressure ◽  
Lung Protective Ventilation ◽  
Positive End Expiratory Pressure ◽  
Current Guidelines

Las actuales guías de manejo del síndrome de distrés respiratorio agudo (SDRA) recomiendan una ventilación protectora: volumen corriente bajo, presión positiva al final de la espiración (PEEP) adecuada y maniobras de reclutamiento alveolar. Sin embargo, estudios recientes han mostrado que la driving pressure podría ser la variable que mejor se correlaciona con la supervivencia en pacientes con SDRA. ABSTRACT Driving pressure and mortality in acute respiratory distress syndrome Current guidelines for ventilation in patients with acute respiratory distress syndrome (ARDS) recommend lung-protective ventilation: use of low tidal volumes, appropiate  positive end-expiratory pressure and alveolar recruitment maneuvers. However, recent studies have shown that driving pressure could be the variable that best correlated with survival in patients with ARDS.

scholarly journals A Lower Tidal Volume Regimen during One-lung Ventilation for Lung Resection Surgery Is Not Associated with Reduced Postoperative Pulmonary Complications

2021 ◽  
Vol 134 (4) ◽  
pp. 562-576
Author(s):  
Douglas A. Colquhoun ◽  
Aleda M. Leis ◽  
Amy M. Shanks ◽  
Michael R. Mathis ◽  
Bhiken I. Naik ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Tidal Volume ◽  
Lung Resection ◽  
Lung Ventilation ◽  
Pulmonary Complications ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Postoperative Pulmonary Complications ◽  
Positive End Expiratory Pressure ◽  
One Lung Ventilation

Background Protective ventilation may improve outcomes after major surgery. However, in the context of one-lung ventilation, such a strategy is incompletely defined. The authors hypothesized that a putative one-lung protective ventilation regimen would be independently associated with decreased odds of pulmonary complications after thoracic surgery. Methods The authors merged Society of Thoracic Surgeons Database and Multicenter Perioperative Outcomes Group intraoperative data for lung resection procedures using one-lung ventilation across five institutions from 2012 to 2016. They defined one-lung protective ventilation as the combination of both median tidal volume 5 ml/kg or lower predicted body weight and positive end-expiratory pressure 5 cm H2O or greater. The primary outcome was a composite of 30-day major postoperative pulmonary complications. Results A total of 3,232 cases were available for analysis. Tidal volumes decreased modestly during the study period (6.7 to 6.0 ml/kg; P &lt; 0.001), and positive end-expiratory pressure increased from 4 to 5 cm H2O (P &lt; 0.001). Despite increasing adoption of a “protective ventilation” strategy (5.7% in 2012 vs. 17.9% in 2016), the prevalence of pulmonary complications did not change significantly (11.4 to 15.7%; P = 0.147). In a propensity score matched cohort (381 matched pairs), protective ventilation (mean tidal volume 6.4 vs. 4.4 ml/kg) was not associated with a reduction in pulmonary complications (adjusted odds ratio, 0.86; 95% CI, 0.56 to 1.32). In an unmatched cohort, the authors were unable to define a specific alternative combination of positive end-expiratory pressure and tidal volume that was associated with decreased risk of pulmonary complications. Conclusions In this multicenter retrospective observational analysis of patients undergoing one-lung ventilation during thoracic surgery, the authors did not detect an independent association between a low tidal volume lung-protective ventilation regimen and a composite of postoperative pulmonary complications. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals A Description of Intraoperative Ventilator Management in Patients with Acute Lung Injury and the Use of Lung Protective Ventilation Strategies

2011 ◽  
Vol 115 (1) ◽  
pp. 75-82 ◽  
Author(s):  
James M. Blum ◽  
Michael Maile ◽  
Pauline K. Park ◽  
Michelle Morris ◽  
Elizabeth Jewell ◽  
...  
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Positive End Expiratory Pressure ◽  
Predicted Body Weight ◽  
Oxygen Oxygen ◽  
Ventilator Management ◽  
Pressure Peak ◽  
Ventilation Strategies

Background The incidence of acute lung injury (ALI) in hypoxic patients undergoing surgery is currently unknown. Previous studies have identified lung protective ventilation strategies that are beneficial in the treatment of ALI. The authors sought to determine the incidence and examine the use of lung protective ventilation strategies in patients receiving anesthetics with a known history of ALI. Methods The ventilation parameters that were used in all patients were reviewed, with an average preoperative PaO₂/Fio₂ [corrected] ratio of ≤ 300 between January 1, 2005 and July 1, 2009. This dataset was then merged with a dataset of patients screened for ALI. The median tidal volume, positive end-expiratory pressure, peak inspiratory pressures, fraction inhaled oxygen, oxygen saturation, and tidal volumes were compared between groups. Results A total of 1,286 patients met criteria for inclusion; 242 had a diagnosis of ALI preoperatively. Comparison of patients with ALI versus those without ALI found statistically yet clinically insignificant differences between the ventilation strategies between the groups in peak inspiratory pressures and positive end-expiratory pressure but no other category. The tidal volumes in cc/kg predicted body weight were approximately 8.7 in both groups. Peak inspiratory pressures were found to be 27.87 cm H₂O on average in the non-ALI group and 29.2 in the ALI group. Conclusion Similar ventilation strategies are used between patients with ALI and those without ALI. These findings suggest that anesthesiologists are not using lung protective ventilation strategies when ventilating patients with low PaO₂/Fio₂ [corrected] ratios and ALI, and instead are treating hypoxia and ALI with higher concentrations of oxygen and peak pressures.

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