Alveolar recruitment strategy and PEEP improve oxygenation, dynamic compliance of respiratory system and end‐expiratory lung volume in pediatric patients undergoing cardiac surgery for congenital heart disease

Scohy, Thierry V.; Bikker, Ido; Hofland, Jan; Jong, Peter L. de; Bogers, Ad J.J.C.; Gommers, Diederik

doi:10.1111/j.1460-9592.2009.03177.x

Cited by 44 publications

(41 citation statements)

References 11 publications

(22 reference statements)

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“…The two PEEP levels were 5 cmH 2 O and 15 [13][14][15][16] cmH 2 O and were well tolerated by all patients. Tables 1 and 2 report the main characteristics of the 30 patients, 29 with ARDS and 1 with ALI.…”

Section: Resultsmentioning

confidence: 99%

“…At the end of each 45 min period, blood was drawn for arterial blood gas measurement and end-expiratory lung volume was measured three times using the nitrogen washout/washin technique, as previously described [13][14][15]. In brief, continuous measurement of end-tidal O 2 and CO 2 during a change in FiO 2 (here, 10%) allows the calculation of nitrogen washout and then washin of the aerated lung volume.…”

Section: Lung Volumesmentioning

confidence: 99%

See 1 more Smart Citation

PEEP-induced changes in lung volume in acute respiratory distress syndrome. Two methods to estimate alveolar recruitment

Dellamonica¹,

Lerolle²,

Sargentini³

et al. 2011

Intensive Care Med

138

128

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Section: Resultsmentioning

confidence: 99%

Section: Lung Volumesmentioning

confidence: 99%

PEEP-induced changes in lung volume in acute respiratory distress syndrome. Two methods to estimate alveolar recruitment

Dellamonica¹,

Lerolle²,

Sargentini³

et al. 2011

Intensive Care Med

138

128

View full text Add to dashboard Cite

show abstract

“…Application of PEEP and recruitment manoeuvres may counteract these side effects of low VT ventilation. The use of moderate levels of PEEP was effective to maintain the end-expiratory lung volume and improve the oxygenation and dynamic compliance of the respiratory system 38. Although the optimal level of PEEP is undetermined, it has been repeatedly shown that the application of zero PEEP was associated with increased hypoxaemia and infections 39 40.…”

Section: Discussionmentioning

confidence: 99%

Effect of protective ventilation on postoperative pulmonary complications in patients undergoing general anaesthesia: a meta-analysis of randomised controlled trials

Tao

Chen

et al. 2014

BMJ Open

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ObjectiveTo determine whether anaesthetised patients undergoing surgery could benefit from intraoperative protective ventilation strategies.MethodsMEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) were searched up to February 2014. Eligible studies evaluated protective ventilation versus conventional ventilation in anaesthetised patients without lung injury at the onset of mechanical ventilation. The primary outcome was the incidence of postoperative pulmonary complications. Included studies must report at least one of the following end points: the incidence of atelectasis or acute lung injury or pulmonary infections.ResultsFour studies (594 patients) were included. Meta-analysis using a random effects model showed a significant decrease in the incidence of atelectasis (OR=0.36; 95% CI 0.22 to 0.60; p<0.0001; I2=0%) and pulmonary infections (OR=0.30; 95% CI 0.14 to 0.68; p=0.004; I2=20%) in patients receiving protective ventilation. Ventilation with protective strategies did not reduce the incidence of acute lung injury (OR=0.40; 95% CI 0.07 to 2.15; p=0.28; I2=12%), all-cause mortality (OR=0.77; 95% CI 0.33 to 1.79; p=0.54; I2=0%), length of hospital stay (weighted mean difference (WMD)=−0.52 day, 95% CI −4.53 to 3.48 day; p=0.80; I2=63%) or length of intensive care unit stay (WMD=−0.55 day, 95% CI −2.19 to 1.09 day; p=0.51; I2=39%).ConclusionsIntraoperative use of protective ventilation strategies has the potential to reduce the incidence of postoperative pulmonary complications in patients undergoing general anaesthesia. Prospective, well-designed clinical trials are warranted to confirm the beneficial effects of protective ventilation strategies in surgical patients.

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“…This ventilator provides bedside EELV measurements by using the multibreath nitrogen-washout technique (MBNW) [8,15-18]. The oxygenation goal was achieved by adjusting FiO 2 , which was maintained constant during the study.…”

Section: Methodsmentioning

confidence: 99%

Accuracy and precision of end-expiratory lung-volume measurements by automated nitrogen washout/washin technique in patients with acute respiratory distress syndrome

et al. 2011

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IntroductionEnd-expiratory lung volume (EELV) is decreased in acute respiratory distress syndrome (ARDS), and bedside EELV measurement may help to set positive end-expiratory pressure (PEEP). Nitrogen washout/washin for EELV measurement is available at the bedside, but assessments of accuracy and precision in real-life conditions are scant. Our purpose was to (a) assess EELV measurement precision in ARDS patients at two PEEP levels (three pairs of measurements), and (b) compare the changes (Δ) induced by PEEP for total EELV with the PEEP-induced changes in lung volume above functional residual capacity measured with passive spirometry (ΔPEEP-volume). The minimal predicted increase in lung volume was calculated from compliance at low PEEP and ΔPEEP to ensure the validity of lung-volume changes.MethodsThirty-four patients with ARDS were prospectively included in five university-hospital intensive care units. ΔEELV and ΔPEEP volumes were compared between 6 and 15 cm H2O of PEEP.ResultsAfter exclusion of three patients, variability of the nitrogen technique was less than 4%, and the largest difference between measurements was 81 ± 64 ml. ΔEELV and ΔPEEP-volume were only weakly correlated (r2 = 0.47); 95% confidence interval limits, -414 to 608 ml). In four patients with the highest PEEP (≥ 16 cm H2O), ΔEELV was lower than the minimal predicted increase in lung volume, suggesting flawed measurements, possibly due to leaks. Excluding those from the analysis markedly strengthened the correlation between ΔEELV and ΔPEEP volume (r2 = 0.80).ConclusionsIn most patients, the EELV technique has good reproducibility and accuracy, even at high PEEP. At high pressures, its accuracy may be limited in case of leaks. The minimal predicted increase in lung volume may help to check for accuracy.

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Alveolar recruitment strategy and PEEP improve oxygenation, dynamic compliance of respiratory system and end‐expiratory lung volume in pediatric patients undergoing cardiac surgery for congenital heart disease

Abstract: An alveolar recruitment strategy with relative high PEEP significantly improves Crs, oxygenation, P(a)CO(2)- PETCO(2) difference, and EELV in pediatric patients undergoing cardiac surgery for congenital heart disease.

Cited by 44 publications

References 11 publications

PEEP-induced changes in lung volume in acute respiratory distress syndrome. Two methods to estimate alveolar recruitment

PEEP-induced changes in lung volume in acute respiratory distress syndrome. Two methods to estimate alveolar recruitment

Effect of protective ventilation on postoperative pulmonary complications in patients undergoing general anaesthesia: a meta-analysis of randomised controlled trials

Accuracy and precision of end-expiratory lung-volume measurements by automated nitrogen washout/washin technique in patients with acute respiratory distress syndrome

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