Optimal PEEP during one-lung ventilation with capnothorax: An experimental study

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorREINIUS, Henrik
dc.contributor.authorBORGES, Joao Batista
dc.contributor.authorENGSTROM, Joakim
dc.contributor.authorAHLGREN, Oskar
dc.contributor.authorLENNMYR, Fredrik
dc.contributor.authorLARSSON, Anders
dc.contributor.authorFREDEN, Filip
dc.date.accessioned2019-02-21T17:28:10Z
dc.date.available2019-02-21T17:28:10Z
dc.date.issued2019
dc.description.abstractBackground One-lung ventilation (OLV) with induced capnothorax carries the risk of severely impaired ventilation and circulation. Optimal PEEP may mitigate the physiological perturbations during these conditions. Methods Right-sided OLV with capnothorax (16 cm H2O) on the left side was initiated in eight anesthetized, muscle-relaxed piglets. A recruitment maneuver and a decremental PEEP titration from PEEP 20 cm H2O to zero end-expiratory pressure (ZEEP) was performed. Regional ventilation and perfusion were studied with electrical impedance tomography and computer tomography of the chest was used. End-expiratory lung volume and hemodynamics were recorded and. Results PaO2 peaked at PEEP 12 cm H2O (49 +/- 14 kPa) and decreased to 11 +/- 5 kPa at ZEEP (P < 0.001). PaCO2 was 9.5 +/- 1.3 kPa at 20 cm H2O PEEP and did not change when PEEP step-wise was reduced to 12 cm H2O PaCO2. At lower PEEP, PaCO2 increased markedly. The ventilatory driving pressure was lowest at PEEP 14 cm H2O (19.6 +/- 5.8 cm H2O) and increased to 38.3 +/- 6.1 cm H2O at ZEEP (P < 0.001). When reducing PEEP below 12-14 cm H2O ventilation shifted from the dependent to the nondependent regions of the ventilated lung (P = 0.003), and perfusion shifted from the ventilated to the nonventilated lung (P = 0.02). Conclusion Optimal PEEP was 12-18 cm H2O and probably relates to capnothorax insufflation pressure. With suboptimal PEEP, ventilation/perfusion mismatch in the ventilated lung and redistribution of blood flow to the nonventilated lung occurred.eng
dc.description.indexMEDLINEeng
dc.description.sponsorshipSwedish Heart and Lung foundation
dc.identifier.citationACTA ANAESTHESIOLOGICA SCANDINAVICA, v.63, n.2, p.222-231, 2019
dc.identifier.doi10.1111/aas.13247
dc.identifier.eissn1399-6576
dc.identifier.issn0001-5172
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/30919
dc.language.isoeng
dc.publisherWILEYeng
dc.relation.ispartofActa Anaesthesiologica Scandinavica
dc.rightsrestrictedAccesseng
dc.rights.holderCopyright WILEYeng
dc.subjectanesthesiaeng
dc.subjectcapnothoraxeng
dc.subjectcardio-thoracic surgeryeng
dc.subjectone lung ventilationeng
dc.subjectoptimal PEEPeng
dc.subjectPEEP titrationeng
dc.subject.otherend-expiratory pressureeng
dc.subject.otherelectrical-impedance tomographyeng
dc.subject.otherthoracoscopic surgeryeng
dc.subject.otheralveolar recruitmenteng
dc.subject.otheroxygenationeng
dc.subject.otherinsufflationeng
dc.subject.otherperfusioneng
dc.subject.otherleveleng
dc.subject.othermechanicseng
dc.subject.otherdynamicseng
dc.subject.wosAnesthesiologyeng
dc.titleOptimal PEEP during one-lung ventilation with capnothorax: An experimental studyeng
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.affiliation.countrySuécia
hcfmusp.affiliation.countryisose
hcfmusp.author.externalREINIUS, Henrik:Uppsala Univ, Dept Surg Sci, Hedenstierna Lab, Sect Anesthesiol & Intens Care, Uppsala, Sweden
hcfmusp.author.externalENGSTROM, Joakim:Uppsala Univ, Dept Surg Sci, Hedenstierna Lab, Sect Anesthesiol & Intens Care, Uppsala, Sweden
hcfmusp.author.externalAHLGREN, Oskar:Uppsala Univ, Dept Surg Sci, Hedenstierna Lab, Sect Anesthesiol & Intens Care, Uppsala, Sweden
hcfmusp.author.externalLENNMYR, Fredrik:Uppsala Univ, Dept Surg Sci, Hedenstierna Lab, Sect Anesthesiol & Intens Care, Uppsala, Sweden; Uppsala Univ Hosp, Dept Cardiothorac Anesthesia, Uppsala, Sweden
hcfmusp.author.externalLARSSON, Anders:Uppsala Univ, Dept Surg Sci, Hedenstierna Lab, Sect Anesthesiol & Intens Care, Uppsala, Sweden
hcfmusp.author.externalFREDEN, Filip:Uppsala Univ, Dept Surg Sci, Hedenstierna Lab, Sect Anesthesiol & Intens Care, Uppsala, Sweden
hcfmusp.citation.scopus7
hcfmusp.contributor.author-fmusphcJOAO BATISTA BORGES SOBRINHO DORINI
hcfmusp.description.beginpage222
hcfmusp.description.endpage231
hcfmusp.description.issue2
hcfmusp.description.volume63
hcfmusp.origemWOS
hcfmusp.origem.pubmed30132806
hcfmusp.origem.scopus2-s2.0-85052617874
hcfmusp.origem.wosWOS:000454814700012
hcfmusp.publisher.cityHOBOKENeng
hcfmusp.publisher.countryUSAeng
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