Effects of PEEP on oxygenation and respiratory mechanics during one-lung ventilation

Michelet, Pierre; Roch, Antoine; Brousse, D.; D’Journo, Xavier Benoit; Brégeon, Fabienne; Lambert, Dominique; Perrin, Gilles; Papazian, Laurent; Thomas, Philippe; Carpentier, J.-P.; Auffray, Jean-Pierre

doi:10.1093/bja/aei178

Cited by 65 publications

(47 citation statements)

References 33 publications

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“…In our study, dynamic compliance of the lung deteriorated at 15 cm H 2 O PEEP, which contradicts the findings published by Kingstedt and co-workers, who used a PEEP of 16 cm H 2 O [12]. Based on the available literature, it can be assumed that decreased compliance of the dependent lung at a PEEP of 15 cm H 2 O resulted from over-distension [26,27] because increases in functional residual capacity with increases in PEEP have their limits [28]. For the above reasons, a PEEP of 5−10 cm H 2 O is considered the best to maintain optimal lung compliance favouring aeration of the lungs without the risk of over-distension [29].…”

Section: Discussioncontrasting

confidence: 99%

Wpływ jednostronnego PEEP na biomechanikę obu płuc podczas niezależnej wentylacji u chorych znieczulanych do zabiegów torakochirurgicznych

Trela-Stachurska¹,

Nestorowicz²,

Kotlińska-Hasiec³

et al. 2015

Anaesthesiol Intensive Ther

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Background: Synchronous independent lung ventilation (ILV) is the treatment of choice for unilateral pathology of lung parenchyma. Numerous studies have documented the improved blood oxygenation and clinical efficacy of this procedure. The aim of the present study was to evaluate the effects of ILV on the selected biomechanical parameters of the lungs. Method: The study involved ASA I-II patients undergoing thoracic surgery in the lateral decubitus position under the standard conditions of general anaesthesia with the thoracic cavity closed. ILV with equal separation of the tidal volume was performed with a prototype volume separator, using incremental a PEEP of 0−15 cm H 2 O in the dependent lung. Peak pressures, dynamic compliance and airway resistance of both lungs were evaluated. Results: The study included 36 patients. In all of the patients, a PEEP of 5−15 cm H 2 O in one lung increased its peak pressures, dynamic compliance and resistances, and variably affected the biomechanical parameters of the other lung. Irrespective of patient positioning on the right or left side, the highest compliance was recorded at a PEEP of 10 cm H 2 O. Conclusions: In ILV, peak pressures and airway resistances are higher in the dependent lung compared to compliances in the non-dependent lung. ILV with a PEEP of 5−15 cm H 2 O increases the biomechanical parameters of the dependent lung while variably influencing the parameters in the non-dependent lung.

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Section: Discussioncontrasting

confidence: 99%

Wpływ jednostronnego PEEP na biomechanikę obu płuc podczas niezależnej wentylacji u chorych znieczulanych do zabiegów torakochirurgicznych

Trela-Stachurska¹,

Nestorowicz²,

Kotlińska-Hasiec³

et al. 2015

Anaesthesiol Intensive Ther

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“…There have been several reports, which have shown that in one-lung ventilation there is ventilation-perfusion mismatch in the dependent, ventilated lung which is prone to collapse during expiration which can induce hypoxemia [1][2][3]. Most studies have focused on changes in hemodynamics or respiratory mechanics of the dependent lung.…”

Section: Introductionmentioning

confidence: 99%

Histochemical Alterations in One Lung Ventilation

Yin¹,

Gribbin²,

Emanuel³

et al. 2007

Journal of Surgical Research

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“…Both experimental and clinical studies have suggested that mechanical ventilation using large tidal volumes could initiate lung injury in healthy lungs, a phenomenon referred as ventilator induced lung injury [1][2][3][4][5][6][7][8][9]. Previous animal [10] and human [11][12][13][14] studies have reported that large tidal volumes and high airway pressures impact adversely on pulmonary and systemic inflammatory responses of non-healthy lungs [15].…”

mentioning

confidence: 99%

A multicentre observational study of intra‐operative ventilatory management during general anaesthesia: tidal volumes and relation to body weight

Coisel²,

et al. 2012

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SummaryWe conducted an observational prospective multicenter study to describe the practices of mechanical ventilation, to determine the incidence of use of large intra-operative tidal volumes ( ‡ 10 ml.kg )1 of ideal body weight) and to identify patient factors associated with this practice. Of the 2960 patients studied in 97 anaesthesia units from 49 hospitals, volume controlled mode was the most commonly used (85%). The mean (SD) tidal volume was 533 (82) ml; 7.7 (1.3) ml.kg )1 (actual weight) and 8.8 (1.4) ml.kg )1 (ideal body weight)). The lungs of 381 (18%) patients were ventilated with a tidal volume > 10 ml.kg )1 ideal body weight. Being female ) and by logistic regression, underweight (OR 0.06 (95% CI 0.01-0.45)), overweight (OR 1.98 (95% CI 1.49-2.65)), obese )), severely obese ) and morbidly obese .03)) were the significant (p £ 0.005) independent factors for the use of large tidal volumes during anaesthesia.

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Effects of PEEP on oxygenation and respiratory mechanics during one-lung ventilation

Abstract: In a healthy porcine lung model of OLV-RH, moderate PEEP can improve oxygenation. This effect implies both expiratory and inspiratory pulmonary recruitment. Co-administration of 4 p.p.m. iNO was ineffective.

Cited by 65 publications

References 33 publications

Wpływ jednostronnego PEEP na biomechanikę obu płuc podczas niezależnej wentylacji u chorych znieczulanych do zabiegów torakochirurgicznych

Wpływ jednostronnego PEEP na biomechanikę obu płuc podczas niezależnej wentylacji u chorych znieczulanych do zabiegów torakochirurgicznych

Histochemical Alterations in One Lung Ventilation

A multicentre observational study of intra‐operative ventilatory management during general anaesthesia: tidal volumes and relation to body weight

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