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

Imagem de Miniatura
Arquivos
art_REINIUS_Optimal_PEEP_during_onelung_ventilation_with_capnothorax_An_2019.PDF (781.02 KB)
Citações na Scopus
7
Tipo de produção
article
Data de publicação
2019
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
WILEY
Autores
REINIUS, Henrik
ENGSTROM, Joakim
AHLGREN, Oskar
LENNMYR, Fredrik
LARSSON, Anders
FREDEN, Filip
Citação
ACTA ANAESTHESIOLOGICA SCANDINAVICA, v.63, n.2, p.222-231, 2019
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background 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.
Palavras-chave
anesthesia, capnothorax, cardio-thoracic surgery, one lung ventilation, optimal PEEP, PEEP titration
URI
https://observatorio.fm.usp.br/handle/OPI/30919
Referências
  1. Amato MBP, 2015, NEW ENGL J MED, V372, P747, DOI 10.1056/NEJMsa1410639
  2. Bardoczky GI, 2000, ANESTH ANALG, V90, P35, DOI 10.1097/00000539-200001000-00008
  3. Borges JB, 2012, J APPL PHYSIOL, V112, P225, DOI 10.1152/japplphysiol.01090.2010
  4. Brock H, 2000, ANAESTHESIA, V55, P10, DOI 10.1046/j.1365-2044.2000.01123.x
  5. Byhahn C, 2001, ANN THORAC SURG, V71, P1496, DOI 10.1016/S0003-4975(01)02428-6
  6. Campos J, 2014, MINERVA ANESTESIOL, V80, P83
  7. Choi YS, 2015, YONSEI MED J, V56, P1421, DOI 10.3349/ymj.2015.56.5.1421
  8. Costa ELV, 2009, INTENS CARE MED, V35, P1132, DOI 10.1007/s00134-009-1447-y
  9. Croft QPP, 2013, PLOS ONE, V8, DOI 10.1371/journal.pone.0067886
  10. El-Dawlatly Abdelazeem, 2002, J Anesth, V16, P13, DOI 10.1007/s540-002-8088-z
  11. Ferrando C, 2014, ANESTH ANALG, V118, P657, DOI 10.1213/ANE.0000000000000105
  12. Frerichs I, 1998, ACTA ANAESTH SCAND, V42, P721, DOI 10.1111/j.1399-6576.1998.tb05308.x
  13. Frerichs I, 2002, IEEE T MED IMAGING, V21, P646, DOI 10.1109/TMI.2002.800585
  14. Girgis K, 2006, RESP CARE, V51, P1132
  15. HOWELL JB, 1961, J APPL PHYSIOL, V16, P71
  16. Karzai W, 2009, ANESTHESIOLOGY, V110, P1402, DOI 10.1097/ALN.0b013e31819fb15d
  17. Kozian A, 2008, BRIT J ANAESTH, V100, P549, DOI 10.1093/bja/aen021
  18. LARSSON A, 1987, ANESTHESIOLOGY, V67, P543, DOI 10.1097/00000542-198710000-00016
  19. Lohser J, 2015, ANESTH ANALG, V121, P302, DOI 10.1213/ANE.0000000000000808
  20. Maisch S, 2008, ANESTH ANALG, V106, P175, DOI 10.1213/01.ane.0000287684.74505.49
  21. MEIER P, 1954, J APPL PHYSIOL, V6, P731
  22. Michelet P, 2005, BRIT J ANAESTH, V95, P267, DOI 10.1093/bja/aei178
  23. Michelet P, 2006, ANESTHESIOLOGY, V105, P911, DOI 10.1097/00000542-200611000-00011
  24. Mukhtar AM, 2008, ANESTH ANALG, V106, P84, DOI 10.1213/01.ane.0000297419.02643.d7
  25. Neumann P, 1998, AM J RESP CRIT CARE, V158, P1636, DOI 10.1164/ajrccm.158.5.9711095
  26. Ohtsuka T, 2001, SURG ENDOSC-ULTRAS, V15, P1327, DOI 10.1007/s00464-001-0037-z
  27. Reinius H, 2015, ACTA ANAESTH SCAND, V59, P354, DOI 10.1111/aas.12455
  28. Rothen HU, 1999, BRIT J ANAESTH, V82, P551
  29. Roze H, 2012, BRIT J ANAESTH, V108, P1022, DOI 10.1093/bja/aes090
  30. Neto AS, 2015, ANESTHESIOLOGY, V123, P66, DOI 10.1097/ALN.0000000000000706
  31. Suarez-Sipmann F, 2007, CRIT CARE MED, V35, P214, DOI 10.1097/01.CCM.0000251131.40301.E2
  32. TARHAN S, 1970, CAN ANAESTH SOC J, V17, P4, DOI 10.1007/BF03004523
  33. THOMPSON HK, 1964, CIRC RES, V14, P502, DOI 10.1161/01.RES.14.6.502
  34. Tran DTT, 2010, HEART LUNG VESSEL, V2, P191
  35. Unzueta C, 2012, BRIT J ANAESTH, V108, P517, DOI 10.1093/bja/aer415
  36. Victorino JA, 2004, AM J RESP CRIT CARE, V169, P791, DOI 10.1164/rccm.200301-133OC
  37. Watanabe S, 2000, ANESTH ANALG, V90, P28, DOI 10.1097/00000539-200001000-00007
  38. Wolf SJ, 2015, PLOS ONE, V10, DOI 10.1371/journal.pone.0135272

Coleções
Artigos e Materiais de Revistas Científicas - FM/Outros
Artigos e Materiais de Revistas Científicas - LIM/09