Effectiveness of positive end-expiratory pressure, decreased fraction of inspired oxygen and vital capacity recruitment maneuver in the prevention of pulmonary atelectasis in patients undergoing general anesthesia: a systematic review

2015 ◽  
Vol 13 (8) ◽  
pp. 211-249 ◽  
Author(s):  
Jennifer Bourgeois Martin ◽  
Deborah Garbee ◽  
Laura Bonanno
Keyword(s):  
Systematic Review ◽  
General Anesthesia ◽  
Vital Capacity ◽  
Recruitment Maneuver ◽  
Positive End Expiratory Pressure ◽  
Pulmonary Atelectasis ◽  
Fraction Of Inspired Oxygen ◽  
Inspired Oxygen

scholarly journals Safety of 80% vs 30–35% fraction of inspired oxygen in patients undergoing surgery: a systematic review and meta-analysis

2019 ◽  
Vol 122 (3) ◽  
pp. 311-324 ◽  
Author(s):  
Katharina Mattishent ◽  
Menaka Thavarajah ◽  
Ashnish Sinha ◽  
Adam Peel ◽  
Matthias Egger ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Fraction Of Inspired Oxygen ◽  
Inspired Oxygen

Set Positive End-expiratory Pressure during Protective Ventilation Affects Lung Injury

2002 ◽  
Vol 97 (3) ◽  
pp. 682-692 ◽  
Author(s):  
Muneyuki Takeuchi ◽  
Sven Goddon ◽  
Marisa Dolhnikoff ◽  
Motomu Shimaoka ◽  
Dean Hess ◽  
...  
Keyword(s):  
Inflection Point ◽  
Peep Level ◽  
Arterial Oxygen ◽  
Positive End Expiratory Pressure ◽  
Lower Inflection Point ◽  
Arterial Oxygen Partial Pressure ◽  
Volume Curve ◽  
Pressure Volume Curve ◽  
Fraction Of Inspired Oxygen ◽  
Inspired Oxygen

Background The most appropriate method of determining positive end-expiratory pressure (PEEP) level during a lung protective ventilatory strategy has not been established. Methods In a lavage-injured sheep acute respiratory distress syndrome model, the authors compared the effects of three approaches to determining PEEP level after a recruitment maneuver: (1) 2 cm H(2)O above the lower inflection point on the inflation pressure-volume curve, (2) at the point of maximum curvature on the deflation pressure-volume curve, and (3) at the PEEP level that maintained target arterial oxygen partial pressure at a fraction of inspired oxygen of 0.5. Results Positive end-expiratory pressure set 2 cm H(2)O above the lower inflection point resulted in the least injury over the course of the study. PEEP based on adequate arterial oxygen partial pressure/fraction of inspired oxygen ratios had to be increased over time and resulted in higher mRNA levels for interleukin-8 and interleukin-1beta and greater tissue inflammation when compared with the other approaches. PEEP at the point of maximum curvature could not maintain eucapneia even at an increased ventilatory rate. Conclusion Although generating higher plateau pressures, PEEP levels based on pressure-volume curve analysis were more effective in maintaining gas exchange and minimizing injury than PEEP based on adequate oxygenation. PEEP at 2 cm H(2)O above the lower inflection point was most effective.

Influence of Gas Composition on Recurrence of Atelectasis after a Reexpansion Maneuver during General Anesthesia

1995 ◽  
Vol 82 (4) ◽  
pp. 832-842. ◽  
Author(s):  
Hans Ulrich Rothen ◽  
Bengt Sporre ◽  
Greta Engberg ◽  
Goran Wegenius ◽  
Marieann Hogman ◽  
...  
Keyword(s):  
Gas Exchange ◽  
General Anesthesia ◽  
Respiratory System ◽  
Vital Capacity ◽  
Recruitment Maneuver ◽  
Arterial Oxygen ◽  
Gas Composition ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Background Atelectasis, an important cause of impaired gas exchange during general anesthesia, may be eliminated by a vital capacity maneuver. However, it is not clear whether such a maneuver will have a sustained effect. The aim of this study was to determine the impact of gas composition on reappearance of atelectasis and impairment of gas exchange after a vital capacity maneuver. Methods A consecutive sample of 12 adults with healthy lungs who were scheduled for elective surgery were studied. Thirty minutes after induction of anesthesia with fentanyl and propofol, the lungs were hyperinflated manually up to an airway pressure of 40 cmH2O. FIO2 was either kept at 0.4 (group 1, n = 6) or changed to 1.0 (group 2, n = 6) during the recruitment maneuver. Atelectasis was assessed by computed tomography. The amount of dense areas was measured at end-expiration in a transverse plane at the base of the lungs. The ventilation-perfusion distributions (VA/Q) were estimated with the multiple inert gas elimination technique. The static compliance of the total respiratory system (Crs) was measured with the flow interruption technique. Results In group 1 (FIO2 = 0.4), the recruitment maneuver virtually eliminated atelectasis for at least 40 min, reduced shunt (VA/Q < 0.005), and increased at the same time the relative perfusion to poorly ventilated lung units (0.005 < VA/Q < 0.1; mean values are given). The arterial oxygen tension (PaO2) increased from 137 mmHg (18.3 kPa) to 163 mmHg (21.7 kPa; before and 40 min after recruitment, respectively; P = 0.028). In contrast to these findings, atelectasis recurred within 5 min after recruitment in group 2 (FIO2 = 1.0). Comparing the values before and 40 min after recruitment, all parameters of VA/Q were unchanged. In both groups, Crs increased from 57.1/55.0 ml.cmH2O-1 (group 1/group 2) before to 70.1/67.4 ml.cmH2O-1 after the recruitment maneuver. Crs showed a slow decrease thereafter (40 min after recruitment: 61.4/60.0 ml.cmH2O-1), with no difference between the two groups. Conclusions The composition of inspiratory gas plays an important role in the recurrence of collapse of previously reexpanded atelectatic lung tissue during general anesthesia in patients with healthy lungs. The reason for the instability of these lung units remains to be established. The change in the amount of atelectasis and shunt appears to be independent of the change in the compliance of the respiratory system.

scholarly journals On the Transition from Control Modes to Spontaneous Modes during ECMO

2021 ◽  
Vol 10 (5) ◽  
pp. 1001
Author(s):  
Krista Stephens ◽  
Nathan Mitchell ◽  
Sean Overton ◽  
Joseph E. Tonna
Keyword(s):  
Respiratory Rate ◽  
Multivariate Regression ◽  
Arterial Oxygen ◽  
High Fidelity ◽  
Positive End Expiratory Pressure ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Fraction Of Inspired Oxygen ◽  
Inspired Oxygen ◽  
Ventilated Patients

The transition from control modes to spontaneous modes is ubiquitous for mechanically ventilated patients yet there is little data describing the changes and patterns that occur to breathing during this transition for patients on ECMO. We identified high fidelity data among a diverse cohort of 419 mechanically ventilated patients on ECMO. We examined every ventilator change, describing the differences in >30,000 sets of original ventilator observations, focused around the time of transition from control modes to spontaneous modes. We performed multivariate regression with mixed effects, clustered by patient, to examine changes in ventilator characteristics within patients, including a subset among patients with low compliance (<30 milliliters (mL)/centimeters water (cmH2O)). We found that during the transition to spontaneous modes among patients with low compliance, patients exhibited greater tidal volumes (471 mL (364,585) vs. 425 mL (320,527); p < 0.0001), higher respiratory rate (23 breaths per minute (bpm) (18,28) vs. 18 bpm (14,23); p = 0.003), greater mechanical power (elastic component) (0.08 mL/(cmH2O × minute) (0.05,0.12) vs. 0.05 mL/(cmH2O × minute) (0.02,0.09); p < 0.0001) (range 0 to 1.4), and lower positive end expiratory pressure (PEEP) (6 cmH2O (5,8) vs. 10 cmH2O (8,11); p < 0.0001). For patients on control modes, the combination of increased tidal volume and increased respiratory rate was temporally associated with significantly low partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio (p < 0.0001). These changes in ventilator parameters warrant prospective study, as they may be associated with worsened lung injury.

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