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- Title
Intraoperative compliance profiles and regional lung ventilation improve with increasing positive end-expiratory pressure.
- Authors
Wirth, S.; Kreysing, M.; Spaeth, J.; Schumann, S.
- Abstract
<bold>Background: </bold>Anaesthesia and mechanical ventilation can lead to impaired lung. Intraoperative positive end-expiratory pressure (PEEP) should prevent intratidal recruitment/derecruitment without causing overdistension. The intratidal compliance profile indicates both unwanted phenomena. We hypothesized that a higher than usual PEEP improves the intratidal compliance and the regional lung ventilation of patients with healthy lungs.<bold>Methods: </bold>After ethics approval, 30 adult patients scheduled for limb surgery were investigated at PEEP 5, 7 and 9 cm H2 O during mechanical ventilation. We calculated the dynamic compliance of the respiratory system (CRS ) and the intratidal volume-dependent CRS curve. The CRS curve indicated intratidal recruitment/derecruitment and/or overdistension. Regional ventilation was measured using electrical impedance tomography.<bold>Results: </bold>At PEEP 5, 7 and 9 cm H2 O, intratidal recruitment/derecruitment was observed in 92%, 84% and 46% (P < 0.05) of the patients respectively. Increasing PEEP was associated with recruitment in the dorsal regions of the lungs (P < 0.001). At PEEP 9 cm H2 O, lung overdistension was indicated in two patients. With PEEP levels up to 9 cm H2 O, no significant effects on haemodynamic variables were found.<bold>Conclusion: </bold>We conclude that in most patients, the often applied PEEP of 5 cm H2 O is insufficient to prevent intratidal recruitment/derecruitment and that few patients show overdistension at high PEEP levels. To establish optimal pressure-volume relationships in the respiratory system, the analysis of the individual intratidal compliance profiles could be a means for individualized perioperative PEEP titration.
- Subjects
PULMONARY ventilation-perfusion scans; ANESTHESIA; ARTIFICIAL respiration; LUNG diseases; RESPIRATORY organ physiology; ELECTRICAL impedance tomography
- Publication
Acta Anaesthesiologica Scandinavica, 2016, Vol 60, Issue 9, p1241
- ISSN
0001-5172
- Publication type
journal article
- DOI
10.1111/aas.12767