In:
Anesthesia & Analgesia, Ovid Technologies (Wolters Kluwer Health), Vol. 126, No. 1 ( 2018-01), p. 143-149
Abstract:
In the 2014 PROtective Ventilation using HIgh versus LOw positive end-expiratory pressure (PROVHILO) trial, intraoperative low tidal volume ventilation with high positive end-expiratory pressure (PEEP = 12 cm H 2 O) and lung recruitment maneuvers did not decrease postoperative pulmonary complications when compared to low PEEP (0–2 cm H 2 O) approach without recruitment breaths. However, effects of intraoperative PEEP on lung compliance remain poorly understood. We hypothesized that higher PEEP leads to a dominance of intratidal overdistension, whereas lower PEEP results in intratidal recruitment/derecruitment (R/D). To test our hypothesis, we used the volume-dependent elastance index % E 2 , a respiratory parameter that allows for noninvasive and radiation-free assessment of dominant overdistension and intratidal R/D. We compared the incidence of intratidal R/D, linear expansion, and overdistension by means of % E 2 in a subset of the PROVHILO cohort. METHODS: In 36 patients from 2 participating centers of the PROVHILO trial, we calculated respiratory system elastance ( E ), resistance ( R ), and % E 2 , a surrogate parameter for intratidal overdistension (% E 2 〉 30%) and R/D (% E 2 〈 0%). To test the main hypothesis, we compared the incidence of intratidal overdistension (primary end point) and R/D in higher and lower PEEP groups, as measured by % E 2 . RESULTS: E was increased in the lower compared to higher PEEP group (18.6 [16…22] vs 13.4 [11.0…17.0] cm H 2 O·L −1 ; P 〈 .01). % E 2 was reduced in the lower PEEP group compared to higher PEEP (−15.4 [−28.0…6.5] vs 6.2 [−0.8…14.0] %; P 〈 .05). Intratidal R/D was increased in the lower PEEP group (61% vs 22%; P = .037). The incidence of intratidal overdistension did not differ significantly between groups (6%). CONCLUSIONS: During mechanical ventilation with protective tidal volumes in patients undergoing open abdominal surgery, lung recruitment followed by PEEP of 12 cm H 2 O decreased the incidence of intratidal R/D and did not worsen overdistension, when compared to PEEP ≤2 cm H 2 O.
Type of Medium:
Online Resource
ISSN:
0003-2999
DOI:
10.1213/ANE.0000000000002192
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2018
detail.hit.zdb_id:
2018275-2
Bookmarklink