Effects of Intraoperative PEEP on Postoperative Arterial Oxygenation

Yakaitis, Ronald W.; Thomas, John D.; Mahaffey, John E.

doi:10.1213/00000539-197507000-00005

Cited by 10 publications

(8 citation statements)

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“…19 Even small amounts of PEEP undoubtedly improve oxygenation during mechanical ventilation, 20 but our results indicate that there is no persistent benefit (or harm), at least over the range of 5 versus 8 cm H 2 O. Our findings are consistent with those of Yakaitis et al, 21 who reported with only 15 patients that intraoperative Pao 2 improved with PEEP, but that improvement was not sustained in the PACU. 21 The initial major trials of mechanical ventilation were conducted in critical care patients, and protective lung ventilation with low tidal volumes, a moderate level of PEEP, and recruitment maneuvers decreased lung injury and reduced morbidity and mortality.…”

Section: Discussionsupporting

confidence: 88%

Tidal Volume and Positive End-expiratory Pressure and Postoperative Hypoxemia during General Anesthesia: A Single-center Multiple Crossover Factorial Cluster Trial

et al. 2022

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Background Intraoperative mechanical ventilation is a major component of general anesthesia. The extent to which various intraoperative tidal volumes and positive end-expiratory pressures (PEEP) on postoperative hypoxia and lung injury remains unclear. We hypothesized that adult patients having orthopedic surgery, ventilation using different tidal volumes and PEEP levels affects the oxygenation within first hour in the postoperative care unit. Methods We conducted a 2 by 2 factorial cross-over cluster trial at the Cleveland Clinic Main Campus. We enrolled patients having orthopedic surgery with general anesthesia who were assigned to factorial clusters with tidal volumes of 6 or 10 ml/kg of predicted body weight and to PEEP of 5 or 8 cm H20 in one-week clusters The primary outcome was the effect of tidal volume or PEEP on time-weighted average peripheral oxygen saturation divided by the fraction of inspired oxygen (SpO2/FiO2 ratio) during the initial postoperative hour. Results We enrolled 2860 patients who had general anesthesia for orthopedic surgery from September 2018 through October 2020. The interaction between tidal volume and PEEP was not significant (p = 0.565). The mean (SD) time-weighted average of SpO2/FiO2 ratio was 353 (47) and not different in patients assigned to high and low tidal volume (estimated effect 3.5% (97.5%CI: -0.4%,7.3%;P=0.042), and for those assigned to high and low PEEP (-0.2% (97.5%CI: -4.0%,3.6%;P=0.906). We did not find significant difference in ward SpO2/FiO2 ratio, pulmonary complications, and duration of hospitalization among patients assigned to various tidal volumes and PEEP levels. Conclusion Among adults having major orthopedic surgery, pulse oximetry oxygenation is similar with tidal volumes between 6 and 10 ml/kg and PEEP between 5 and 8 cm H20. Our results suggest that any combination of tidal volumes between 6 and 10 ml/kg and PEEP between 5 vs. 8 mL cmH20 can be used safely for orthopedic surgery. Trial Registration ClinicalTrials.gov Identifier: NCT03657368.

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Section: Discussionsupporting

confidence: 88%

Tidal Volume and Positive End-expiratory Pressure and Postoperative Hypoxemia during General Anesthesia: A Single-center Multiple Crossover Factorial Cluster Trial

et al. 2022

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“…P , 0.05 was considered significant. Groups, median (minimum-maximum) 14 reported that the highest mean PO 2 levels were detected in patients to whom 10 cm of H 2 O PEEP was applied during the surgery, although this beneficial effect was not maintained after the operation. Conversely, a significantly higher PO 2 / FiO 2 ratio on the first postoperative day in the PEEP group has been revealed by two trials.…”

Section: Discussionmentioning

confidence: 99%

“…The application of PEEP is widely accepted in cases of hypoxemia caused by reduced functional residual capacity. [13][14][15] Previous studies suggest that an adequate PEEP ventilation mode improves pulmonary functions and thus results in increased arterial and peripheral tissue oxygenation. [16][17][18] However, no measurements were recorded postoperatively in these earlier studies.…”

Section: Discussionmentioning

confidence: 99%

Effect of Intraoperative PEEP Application on Colonic Anastomoses Healing: An Experimental Animal Study

Türkoğlu

Bostancı

Bilgili

et al. 2016

International Surgery

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This study aimed to assess the effect of intraoperative positive end-expiratory pressure (PEEP) intervention on the healing of colonic anastomoses in rabbits. A total of 32 New Zealand type male rabbits were divided into 2 groups of 16 animals each. Following ventilation with tracheostomy, colonic resection and anastomosis were performed in both groups. Although 10 cm of H 2 O PEEP level was applied in group 1 (PEEP), group 2 [zero end-expiratory pressure (ZEEP)] was ventilated without PEEP throughout the surgery. Half of both the PEEP and ZEEP group animals were killed on the third postoperative day, whereas the remaining half were killed on the seventh. Anastomotic bursting pressures, the tissue concentrations in hydroxyproline, and histologic assessments were

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“…8 PEEP improves intraoperative oxygenation. [9][10][11][12] PEEP decreases atelectasis (especially in obese patients following a recruitment manoeuvre), 13 decreases airway closure and increases lung volume. 14,15 However, high levels of PEEP may also impair oxygenation in non-obese patients.…”

Section: Introductionmentioning

confidence: 99%