Effect of vital capacity manoeuvres on arterial oxygenation in morbidly obese patients undergoing open bariatric surgery

Abstract

The addition of VCM to PEEP improves intraoperative arterial oxygenation in morbidly obese patients undergoing open bariatric surgery.

Ventilation strategies in obese patients undergoing surgery: a quantitative systematic review and meta-analysis

“…From five of those (182 patients), outcome data could be extracted and combined. 14 There were not enough data on other outcomes to draw any meaningful conclusions.…”

Perioperative management of the severely obese patient: a selective pathophysiological review

“…Common sense would suggest the application of PEEP, and the addition of periodic recruitment maneuvers (repeated sustained lung inflation with peak pressures of 40 cm H 2 O have been used) or vital capacity maneuvers has been shown to improve oxygenation beyond the application of PEEP alone. 96,97 These maneuvers should be followed by the application of PEEP to maintain recruitment. Positive end-expiratory pressure values of 10 cm H 2 O applied after recruitment/vital capacity maneuvers produce a lower A-a gradient than the application of zero PEEP (known as ZEEP) or 5 cm H 2 O PEEP in obese patients undergoing laparoscopic surgery.…”

Ventilação não invasiva no pós-operatório imediato de derivação gastrojejunal com bypass em Y de Roux

“…This indicates better oxygenation levels with the use of NIV, probably due to an increase in functional residual capacity (FRC). Several ventilation strategies have been assessed for their effect on improving arterial oxygenation during the intraoperative period in patients with morbid obesity 21 . The use of CPAP restores the FRC to preoperative levels, improving PO oxygenation 3 .…”

“…The authors concluded that PEEP levels of around 15 cmH 2 O were necessary to prevent lung collapse and to improve gas exchange in morbidly obese patients. Chalhoub et al 21 assessed the effects of the vital capacity maneuver (VCM) in morbidly obese subjects submitted to open bariatric surgery and found that PEEP levels of 8 cmH 2 O associated to VCM were sufficient to significantly improve arterial oxygenation and to avoid hemodynamic instability. The levels of IPAP and EPAP used in the present study were based on these previous findings.…”