scholarly journals Efficacy of Alveolar Recruitment Maneuvers in the Adult Obese Patient Undergoing General Anesthesia: A Systematic Review of the Literature

2018 ◽  
Author(s):  
Joseph Banks
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
General Anesthesia ◽  
Obese Patient ◽  
Perioperative Period ◽  
Lung Compliance ◽  
Alveolar Recruitment ◽  
Respiratory Physiology ◽  
Arterial Oxygen ◽  
Recruitment Maneuvers

There are many pathophysiologic health effects associated with obesity, and the effects on normal respiratory physiology can be profound. The presence of increased adipose tissue can limit a patient’s functional residual capacity, reduce end expiratory lung volumes, and increase small airway closure. When exposed to general anesthesia with mechanical ventilation these physiologic changes can increase atelectasis development and increase the likelihood of ventilation-perfusion mismatching. Alveolar recruitment maneuvers are brief applications of positive airway pressure that are employed to recruit alveoli that have already collapsed and prevent new atelectasis formation. The purpose of this systematic review was to determine if the use of alveolar recruitment maneuvers are a safe and effective treatment strategy for managing the adult obese patient requiring general anesthesia with mechanical ventilation. The theoretical framework that guided this systematic review was the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Randomized control trials that utilized alveolar recruitment maneuvers in adult obese patients were reviewed and appraised for inclusion in this systematic review. It was determined that alveolar recruitment maneuvers are a safe and effective strategy for minimizing atelectasis development in the adult obese patient undergoing general anesthesia. Alveolar recruitment maneuvers were associated with an improved intraoperative oxygenation, a decreased alveolar-arterial oxygen concentration gradient, and improved lung compliance. Furthermore, alveolar recruitment maneuver use demonstrated a decrease in atelectasis development measured via computed tomography and radiograph imaging. Application of these maneuvers in the obese patient during the perioperative period can improve ventilation-perfusion matching and decrease respiratory complications associated with atelectasis development.

scholarly journals Evaluation of alveolar recruitment maneuver on respiratory resistance during general anesthesia: a prospective observational study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Junko Nakahira ◽  
Shoko Nakano ◽  
Toshiaki Minami
Keyword(s):  
Mechanical Ventilation ◽  
General Anesthesia ◽  
Recruitment Maneuver ◽  
Peak Inspiratory Pressure ◽  
Alveolar Recruitment ◽  
Trial Registration ◽  
Inspiratory Pressure ◽  
Forced Oscillation Technique ◽  
Respiratory Resistance ◽  
Recruitment Maneuvers

Abstract Background Alveolar recruitment maneuvers enable easily reopening nonaerated lung regions via a transient elevation in transpulmonary pressure. To evaluate the effect of these maneuvers on respiratory resistance, we used an oscillatory technique during mechanical ventilation. This study was conducted to assess the effect of the alveolar recruitment maneuvers on respiratory resistance under routine anesthesia. We hypothesized that respiratory resistance at 5 Hz (R5) after the maneuver would be decreased after the lung aeration. Methods After receiving the ethics committee’s approval, we enrolled 33 patients who were classified with an American Society of Anesthesiologists physical status of 1, 2 or 3 and were undergoing general anesthesia for transurethral resection of a bladder tumor within a 12-month period from 2017 to 2018. The recruitment maneuver was performed 30 min after endotracheal intubation. The maneuver consisted of sustained manual inflation of the anesthesia reservoir bag to a peak inspiratory pressure of 40 cmH2O for 15 s, including 5 s of gradually increasing the peak inspiratory pressure. Respiratory resistance was measured using the forced oscillation technique before and after the maneuver, and the mean R5 was calculated during the expiratory phase. The respiratory resistance and ventilator parameter results were analyzed using paired Student’s t-tests, and p < 0.05 was considered statistically significant. Results We analyzed 31 patients (25 men and 6 women). R5 was 7.3 ± 1.6 cmH2O/L/sec before the recruitment maneuver during mechanical ventilation and was significantly decreased to 6.4 ± 1.7 cmH2O/L/sec after the maneuver. Peak inspiratory pressure and plateau pressure were significantly decreased, and pulmonary compliance was increased, although the values were not clinically relevant. Conclusion The recruitment maneuver decreased respiratory resistance and increased lung compliance during mechanical ventilation. Trial registration Name of registry: Japan Medical Association Center for Clinical Trials. Trial registration number: reference JMA-IIA00136. Date of registration: 2 September 2013. URL of trial registry record: https://dbcentre3.jmacct.med.or.jp/JMACTR/App/JMACTRE02_04/JMACTRE02_04.aspx?kbn=3&seqno=3582

scholarly journals The Effect of Positive End Expiratory Pressure (PEEP) with Recruitment Maneuvers on Atelectasis in Obese Patients Undergoing Abdominal Surgery: A Systematic Review

2019 ◽  
Author(s):  
Jon Cerami
Keyword(s):  
Systematic Review ◽  
Abdominal Surgery ◽  
General Anesthesia ◽  
Surgical Procedures ◽  
Alveolar Recruitment ◽  
Obese Patients ◽  
Arterial Oxygenation ◽  
Positive End Expiratory Pressure ◽  
Recruitment Maneuvers ◽  
Obese Population

General anesthesia has a profound effect on respiratory dynamics in the obese population. Obesity can contribute to a decreased functional residual capacity, reduced lung volumes, and an increased closing capacity. Positioning and procedural requirements can further complicate the respiratory status of the obese patient. Surgical procedures in the obese population have an increased risk for the formation of atelectasis. Ventilation can be compromised due to atelectatic lung tissue and may result in post operative complications such as pneumonia, acute respiratory distress, hypoxia, a prolonged hospital stay, and the need for prolonged mechanical ventilation. Positive end-expiratory pressure (PEEP) is utilized in the operating room to increase arterial oxygenation, prevent airway collapse and expand alveoli during each breath. Alveolar recruitment maneuvers can be supplementary throughout surgical procedures to recruit and restore atelectatic lung tissue and prevent further formation of atelectasis. The purpose of this systematic review was to evaluate the effect of PEEP with recruitment maneuvers in obese patients undergoing abdominal surgery with general anesthesia. The theoretical framework that guided this systematic review was the Preferred Reporting Items for Systematic Review and Meta- Analysis (PRISMA) Statement. Randomized control trials included in this systematic review were appraised using the Critical Appraisal Skills Programme (CASP) to evaluate reliability. Alveolar recruitment maneuvers increase lung compliance, arterial oxygenation, and decrease complications associated with atelectasis formation. The use of PEEP with alveolar recruitment maneuvers should be employed for obese patients that undergo abdominal surgery with general anesthesia.

scholarly journals The Effect of Ultrasound-Guided Lung Recruitment Maneuvers On Atelectasis In Lung-Healthy Patients Undergoing Laparoscopic Gynecologic Surgery: a Randomized Controlled Trial

2021 ◽  
Author(s):  
Yi Liu ◽  
Jingyu Wang ◽  
Yong Wan ◽  
Yuan Geng ◽  
Yiran Zhang ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
General Anesthesia ◽  
Lung Ultrasound ◽  
Pulmonary Complications ◽  
Lung Recruitment ◽  
Gynecologic Surgery ◽  
Postoperative Pulmonary Complications ◽  
Ultrasound Guided ◽  
Recruitment Maneuvers ◽  
Laparoscopic Gynecologic Surgery

Abstract BackgroundAtelectasis is a major cause of hypoxemia during general anesthesia and postoperative pulmonary complications (PPCs).Some previous reported that the combined use of lung recruitment procedures (LRMs) and positive end-expiratory pressure (PEEP) in mechanical ventilation mode contributes to the avoidance of PPCs in patients after general anesthesia, while others suggest that the use of LRMs makes patients more susceptible to hemodynamic disturbances and lung injury, and is of limited potential to decrease the incidence of PPCs. From this perspective, controversy exists as to whether LRMs should be routinely applied to surgical patients. More importantly, corresponding clinical studies are also lacking. Therefore, this trial was conducted with the aim of solving the above problem.MethodsIn current clinical trial, patients undergoing laparoscopic gynecologic surgery with healthy lungs were randomized to the recruitment maneuvers group (RM group; 6 cm H2O PEEP and RMs) and the control group (C group; 6 cm H2O PEEP and no RMs). Lung ultrasound was performed on patients at five separate time points. During mechanical ventilation, patients in the RM group received ultrasound-guided pulmonary resuscitation when atelectasis was detected, while the C group did not intervene. Lung ultrasound scores were used to evaluate the incidence and severity of atelectasis.ResultsAfter LRMs, the incidence of atelectasis was significantly lower in the RM group (40%) than in the C group (80%) 15 minutes after arrival in the post-anesthesia care unit (PACU), and this difference did not persist for 24 hours after surgery. Meanwhile, postoperative pulmonary complications showed no difference between the two groups.ConclusionsThe combination of LRMs and PEEP decreased the incidence of atelectasis 15 minutes after admission to the PACU, but did not improve PPCs in adults with healthy lungs. Hence, for lung-healthy patients undergoing gynecological laparoscopic surgery, we do not recommend routine recruitment maneuvers. Trial registration: (prospectively registered): ChiCTR2000033529. Registered on 6/4/2020.

Practical Review of Mechanical Ventilation in Adults and Children in The Operating Room and Emergency Department

2021 ◽  
Vol 16 ◽  
Author(s):  
Christian Zanza ◽  
Yaroslava Longhitano ◽  
Mirco Leo ◽  
Tatsiana Romenskaya ◽  
Francesco Franceschi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Operating Room ◽  
Protective Ventilation ◽  
Alveolar Recruitment ◽  
Cochrane Library ◽  
Surgical Patient ◽  
Emergency Setting ◽  
Recruitment Maneuvers ◽  
Operative Complications ◽  
Post Operative Complications

Background: During general anesthesia, mechanical ventilation can cause pulmonary damage through mechanism of ventilator-induced lung injury which is a major cause of postoperative pulmonary complications, which varies between 5 and 33% and increases significantly the 30-day mortality of the surgical patient. Objective: The aim of this review is to analyze different variables which played key role in safe application of mechanical ventilation in the operating room and emergency setting. Method: Also, we wanted to analyze different types of population that underwent intraoperative mechanical ventilation like obese patients, pediatric and adult population and different strategies such as one lung ventilation and ventilation in trendelemburg position. The peer-reviewed articles analyzed were selected according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) from Pubmed/Medline, Ovid/Wiley and Cochrane Library, combining key terms such as: “pulmonary post-operative complications”, “protective ventilation”, “alveolar recruitment maneuvers”, “respiratory compliance”, “intraoperative paediatric ventilation”, “best peep”, “types of ventilation”. Among the 230 papers identified, 150 articles were selected, after title - abstract examination and removing the duplicates, resulting in 94 articles related to mechanical ventilation in operating room and emergency setting that were analyzed. Results: Careful preoperative patient’s evaluation and protective ventilation (i.e. use of low tidal volumes, adequate PEEP and alveolar recruitment maneuvers) has been shown to be effective not only in limiting alveolar de-recruitment, alveolar overdistension and lung damage, but also in reducing the onset of pulmonary post-operative complications (PPCs). Conclusion: Mechanical ventilation is like “Janus Bi-front” because it is essential for surgical procedures, for the care of critical care patients and in life-threatening conditions but it can be harmful to the patient if continued for a long time and where an excessive dose of oxygen is administered into the lungs. Low tidal volume is associated with minor rate of PPCs and other complications and every complication can increase length of Stay, adding cost to NHS between 1580 € and 1650 € per day in Europe and currently the prevention of PPCS is only weapon that we possess.

scholarly journals The Effect of an Alveolar Recruitment Strategy on Oxygenation during Laparascopic Cholecystectomy

2003 ◽  
Vol 31 (2) ◽  
pp. 176-180 ◽  
Author(s):  
C. K. Pang ◽  
J. Yap ◽  
P. P. Chen
Keyword(s):  
Mechanical Ventilation ◽  
Laparoscopic Cholecystectomy ◽  
Airway Pressure ◽  
Controlled Trial ◽  
Alveolar Recruitment ◽  
Recruitment Strategy ◽  
Arterial Oxygen ◽  
Control Group ◽  
Arterial Oxygenation ◽  
Significant Difference

This prospective randomized controlled trial examined the effect of an “alveolar recruitment strategy” (ARS) in healthy patients having laparoscopic cholecystectomy. Twenty-four consecutive ASA 1 or 2 patients were randomly allocated to an ARS or control group. All patients were manually ventilated to a maximal airway pressure of 25 to 30 cmH 2 O or a tidal volume of 10 ml/kg during induction of general anaesthesia. After intubation, the control group was ventilated with standardized mechanical ventilation settings. The ARS group was manually ventilated to an airway pressure of 40 cmH 2 O for 10 breaths over one minute, followed by mechanical ventilation with similar standardized settings plus 5 cmH 2 0 positive end-expiratory pressure. Blood pressure, heart rate, arterial oxygen and carbon dioxide tension (PaO 2 and PaCO 2 ) was measured pre-induction, 20 minutes post induction but before abdominal insufflation, 20 minutes after abdominal insufflation, and 20 minutes after arrival in the recovery room. Demographic and operation data were similar. The ARS group pre-insufflation PaO 2 [30.16 (9.43)] was higher than the control group [22.19 (9.08)] (P=0.047). There was a significant difference in PaO 2 between the ARS [23.94 (4.87)] and control [17.26 (3.93)] groups during the post-insufflation period (P=0.001). There were no significant differences in PaO 2 between the groups during baseline and recovery periods. No adverse effects were reported. ARS improved arterial oxygenation intraoperatively in healthy patients having laparoscopic cholecystectomy, without clinical cardiovascular compromise or respiratory complication. We conclude that this alveolar recruitment strategy is a useful method of increasing arterial oxygenation.

scholarly journals Lung Ultrasonography in the Monitoring of Intraoperative Recruitment Maneuvers

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 276
Author(s):  
Jolanta Cylwik ◽  
Natalia Buda
Keyword(s):  
General Anesthesia ◽  
Peak Pressure ◽  
Perioperative Complications ◽  
Lung Compliance ◽  
Chest Ultrasonography ◽  
Simultaneous Reduction ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Recruitment Maneuvers ◽  
Ventilated Patients

Introduction: Postoperative respiratory failure is a serious problem in patients who undergo general anesthesia. Approximately 90% of mechanically ventilated patients during the surgery may develop atelectasis that leads to perioperative complications. Aim: The aim of this study is to determine whether it is possible to optimize recruitment maneuvers with the use of chest ultrasonography, thus limiting the risk of respiratory complications in patients who undergo general anesthesia. Methodology: The method of incremental increases in positive end-expiratory pressure (PEEP) values with simultaneous continuous ultrasound assessments was employed in mechanically ventilated patients. Results: The study group comprised 100 patients. The employed method allowed for atelectasis reduction in 91.9% of patients. The PEEP necessary to reverse areas of atelectasis averaged 17cmH2O, with an average peak pressure of 29cmH2O. The average PEEP that prevented repeat atelectasis was 9cmH2O. A significant improvement in lung compliance and saturation was obtained. Conclusions: Ultrasound-guided recruitment maneuvers facilitate the patient-based adjustment of the process. Consequently, the reduction in ventilation pressures necessary to aerate intraoperative atelectasis is possible, with the simultaneous reduction in the risk of procedure-related complications.

scholarly journals Respiratory Physiology for the Anesthesiologist

2019 ◽  
Vol 130 (6) ◽  
pp. 1064-1077 ◽  
Author(s):  
Luca Bigatello ◽  
Antonio Pesenti
Keyword(s):  
Carbon Dioxide ◽  
Mechanical Ventilation ◽  
Gas Exchange ◽  
General Anesthesia ◽  
Respiratory Function ◽  
Respiratory Mechanics ◽  
Respiratory Physiology ◽  
Current Work ◽  
Pressure Flow

Abstract Respiratory function is fundamental in the practice of anesthesia. Knowledge of basic physiologic principles of respiration assists in the proper implementation of daily actions of induction and maintenance of general anesthesia, delivery of mechanical ventilation, discontinuation of mechanical and pharmacologic support, and return to the preoperative state. The current work provides a review of classic physiology and emphasizes features important to the anesthesiologist. The material is divided in two main sections, gas exchange and respiratory mechanics; each section presents the physiology as the basis of abnormal states. We review the path of oxygen from air to the artery and of carbon dioxide the opposite way, and we have the causes of hypoxemia and of hypercarbia based on these very footpaths. We present the actions of pressure, flow, and volume as the normal determinants of ventilation, and we review the resulting abnormalities in terms of changes of resistance and compliance.

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