Intraoperative Ventilation Patterns in Morbidly Obese Patients Undergoing Laparoscopic Bariatric Surgery

Abstract

The significant variation in TV per kg IBW as well as in PEEP values at our institution may reflect the lack of well-established guidelines for intraoperative ventilation. Many patients in this study received inappropriately large TVs (>8 mL/kg IBW), which may be due to calculation of TVs based on total body weight rather than IBW. Patients of shorter stature and higher body mass index appear to be at higher risk for ventilation with inappropriately large TVs.

A review of electrical impedance tomography in lung applications: Theory and algorithms for absolute images

“…Perioperative patients may have healthy lungs; however, guidelines for ventilation settings might not be well-established and might cause ventilator-induced lung injury [183]. It is feasible to use EIT to individualize tidal volume and PEEP before surgery [184,185].…”

Electrical Impedance tomography – recent applications and developments

“…EIT generates cross-sectional images of the internal distribution of electrical impedance continuously at the bedside, which explains its high temporal resolution [ 42 , 43 ]. Poor posture means the solution for intrathoracic impedances may be unstable: small errors in voltage measurements disrupt reconstruction.…”

“…It has also been shown that in order to refine the measurements, the estimation of lung function from data obtained from the sixth intercostal space is more reliable than that obtained from the fourth intercostal space. Finally, a seated position is easier to tolerate by the subjects [ 42 ].…”