scholarly journals Exploring the intraoperative lung protective ventilation of different positive end-expiratory pressure levels during abdominal laparoscopic surgery with Trendelenburg position

2019 ◽  
Vol 7 (8) ◽  
pp. 171-171
Author(s):  
Yun Wang ◽  
Hong Wang ◽  
Huijuan Wang ◽  
Xiao Zhao ◽  
Shitong Li ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Positive End Expiratory Pressure ◽  
Trendelenburg Position

scholarly journals The tidal volume challenge improves the reliability of dynamic preload indices during robot-assisted laparoscopic surgery in the Trendelenburg position with lung-protective ventilation

2019 ◽  
Author(s):  
Joo-Hyun Jun ◽  
Rack Kyung Chung ◽  
Hee Jung Baik ◽  
Mi Hwa Chung ◽  
Joon-Sang Hyeon ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Stroke Volume ◽  
Tidal Volume ◽  
Fluid Responsiveness ◽  
Protective Ventilation ◽  
Volume Index ◽  
Lung Protective Ventilation ◽  
Predictive Capability ◽  
Robot Assisted ◽  
Trendelenburg Position

Abstract Background: The reliability of pulse pressure variation (PPV) and stroke volume variation (SVV) is controversial under pneumoperitoneum. In addition, the usefulness of these indices is being called into question with the increasing adoption of lung-protective ventilation using low tidal volume (VT) in surgical patients. A recent study indicated that changes in PPV or SVV obtained by transiently increasing VT (VT challenge) accurately predicted fluid responsiveness even in critically ill patients receiving low VT. We evaluated whether the changes in PPV and SVV induced by a VT challenge predicted fluid responsiveness during pneumoperitoneum. Methods: We performed an interventional prospective study in patients undergoing robot-assisted laparoscopic surgery in the Trendelenburg position under lung-protective ventilation. PPV, SVV, and the stroke volume index (SVI) were measured at a VT of 6 mL/kg and 3 minutes after increasing the VT to 8 mL/kg. The VT was reduced to 6 mL/kg, and measurements were performed before and 5 minutes after volume expansion (infusing 6% hydroxyethyl starch 6 ml/kg over 10 minutes). Fluid responsiveness was defined as ≥ 15% increase in the SVI. Results: Twenty-four of the 38 patients enrolled in the study were responders. In the receiver operating characteristic curve analysis, an increase in PPV > 1% after the VT challenge showed excellent predictive capability for fluid responsiveness, with an area under the curve (AUC) of 0.95 [95% confidence interval (CI), 0.83–0.99, P < 0.0001; sensitivity 92%, specificity 86%]. An increase in SVV > 2% after the VT challenge predicted fluid responsiveness, but showed only fair predictive capability, with an AUC of 0.76 (95% CI, 0.60–0.89, P < 0.0006; sensitivity 46%, specificity 100%). The augmented values of PPV and SVV following VT challenge also showed the improved predictability of fluid responsiveness compared to PPV and SVV values (as measured by VT) of 6 ml/kg. Conclusions: The change in PPV following the VT challenge has excellent reliability in predicting fluid responsiveness in our surgical population. The change in SVV and augmented values of PPV and SVV following this test are also reliable.

scholarly journals Temporary increase in tidal volume to improve the reliability of dynamic preload indices during robot-assisted laparoscopic surgery in the Trendelenburg position with lung-protective ventilation

2019 ◽  
Author(s):  
Joo-Hyun Jun ◽  
Rack Kyung Chung ◽  
Hee Jung Baik ◽  
Mi Hwa Chung ◽  
Joon-Sang Hyeon ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Stroke Volume ◽  
Tidal Volume ◽  
Fluid Responsiveness ◽  
Protective Ventilation ◽  
Volume Index ◽  
Lung Protective Ventilation ◽  
Temporary Increase ◽  
Robot Assisted ◽  
Trendelenburg Position

Abstract Background: Pulse pressure variation (PPV) and stroke volume variation (SVV) induced by mechanical ventilation are widely used as predictors of fluid responsiveness. However, the reliability of these dynamic preload indices is controversial under pneumoperitoneum. In addition, the usefulness of these indices is being called into question with the increasing adoption of lung-protective ventilation using low tidal volume (VT) in surgical patients. We investigated whether increasing tidal volume (VT) from 6 to 8 ml/kg can improve the predictive power of PPV and SVV during pneurmoperitoneum. Methods: We performed a prospective observational study in patients undergoing robot-assisted laparoscopic surgery in the Trendelenburg position under lung-protective ventilation. PPV, SVV, and the stroke volume index (SVI) were measured at a VT of 6 mL/kg and 3 minutes after increasing the VT to 8 mL/kg. The VT was reduced to 6 mL/kg, and measurements were performed before and 5 minutes after volume expansion (infusing 6% hydroxyethyl starch 6 ml/kg over 10 minutes). Fluid responsiveness was defined as ≥ 15% increase in the SVI. Results: Twenty-four of the 38 patients enrolled in the study were responders. In the receiver operating characteristic curve analysis, the augmented PPV and SVV associated with a temporary increase in VT from 6 to 8 ml/kg improved the predictability of fluid responsiveness, with area under the curve (AUC) values of 0.85 (95% confidence interval (CI), 0.70–0.95, P < 0.0001) and 0.77 (95% CI 0.61–0.89, P = 0.0003), compared to PPV and SVV values (as measured by VT) of 6 ml/kg. The absolute change in PPV and SVV values obtained by transiently increasing VT also predicted fluid responsiveness, with AUC values of 0.95 (95% CI 0.83–0.99, P < 0.0001) and 0.76 (95% CI 0.60–0.89, P = 0.0006). Conclusions: Augmented PPV and SVV values, and absolute changes therein obtained by increasing VT from 6 to 8 ml/kg, predicted fluid responsiveness with high sensitivity and specificity in our surgical population.

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 Effect of pressure-controlled ventilation-volume guaranteed mode combined with individualized positive end-expiratory pressure on respiratory mechanics, oxygenation and lung injury in patients undergoing laparoscopic surgery in Trendelenburg position

2021 ◽  
Author(s):  
Jianli Li ◽  
Saixian Ma ◽  
Xiujie Chang ◽  
Songxu Ju ◽  
Meng Zhang ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Lung Injury ◽  
Respiratory Mechanics ◽  
Lung Mechanics ◽  
Trial Registry ◽  
Positive End Expiratory Pressure ◽  
Clinical Trial Registry ◽  
Trendelenburg Position ◽  
Pressure Controlled Ventilation ◽  
Pressure Controlled

AbstractThe study aimed to investigate the efficacy of PCV-VG combined with individual PEEP during laparoscopic surgery in the Trendelenburg position. 120 patients were randomly divided into four groups: VF group (VCV plus 5cmH2O PEEP), PF group (PCV-VG plus 5cmH2O PEEP), VI group (VCV plus individual PEEP), and PI group (PCV-VG plus individual PEEP). Pmean, Ppeak, Cdyn, PaO2/FiO2, VD/VT, A-aDO2 and Qs/Qt were recorded at T1 (15 min after the induction of anesthesia), T2 (60 min after pneumoperitoneum), and T3 (5 min at the end of anesthesia). The CC16 and IL-6 were measured at T1 and T3. Our results showed that the Pmean was increased in VI and PI group, and the Ppeak was lower in PI group at T2. At T2 and T3, the Cdyn of PI group was higher than that in other groups, and PaO2/FiO2 was increased in PI group compared with VF and VI group. At T2 and T3, A-aDO2 of PI and PF group was reduced than that in other groups. The Qs/Qt was decreased in PI group compared with VF and VI group at T2 and T3. At T2, VD/VT in PI group was decreased than other groups. At T3, the concentration of CC16 in PI group was lower compared with other groups, and IL-6 level of PI group was decreased than that in VF and VI group. In conclusion, the patients who underwent laparoscopic surgery, PCV-VG combined with individual PEEP produced favorable lung mechanics and oxygenation, and thus reducing inflammatory response and lung injury.Clinical Trial registry: chictr.org. identifier: ChiCTR-2100044928

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.

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