Intrathoracic Airway Closure Impacts CO<sub>2</sub> Signal and Delivered Ventilation during Cardiopulmonary Resuscitation

Grieco, Domenico Luca; Brochard, Laurent; Drouet, Adrien; Telias, Irene; Delisle, Stéphane; Bronchti, Gilles; Ricard, C.; Rigollot, Marceau; Badat, Bilal; Ouellet, Paul; Charbonney, Emmanuel; Mancebo, Jordi; Mercat, Alain; Savary, Dominique; Richard, Jean-Christophe M.

doi:10.1164/rccm.201806-1111oc

Cited by 53 publications

(63 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Airway closure with a variable degree of opening pressure has been documented in patients with acute respiratory distress syndrome, in human cadavers, and in cardiac arrest patients undergoing cardiopulmonary resuscitation. 1,4,23,24 Different from what initially suggested during general anesthesia, 6,7 the opening pressure is not an airway pressure threshold to overcome pleural pressure and generate positive transpulmonary pressure. Indeed, this phenomenon has been reported in the excised lung, where transpulmonary pressure is necessarily positive, 25,26 and in our study, airway opening often occurred at a transpulmonary pressure lower Fig.…”

Section: Discussionmentioning

confidence: 85%

See 1 more Smart Citation

Airway Closure during Surgical Pneumoperitoneum in Obese Patients

Grieco¹,

Anzellotti²,

Russo³

et al. 2019

Anesthesiology

View full text Add to dashboard Cite

Background: Airway closure causes lack of communication between proximal airways and alveoli, making tidal inflation start only after a critical airway opening pressure is overcome. The authors conducted a matched cohort study to report the existence of this phenomenon among obese patients undergoing general anesthesia.Methods: Within the procedures of a clinical trial during gynecological surgery, obese patients underwent respiratory/lung mechanics and lung volume assessment both before and after pneumoperitoneum, in the supine and Trendelenburg positions, respectively. Among patients included in this study, those exhibiting airway closure were compared to a control group of subjects enrolled in the same trial and matched in 1:1 ratio according to body mass index.results: Eleven of 50 patients (22%) showed airway closure after intubation, with a median (interquartile range) airway opening pressure of 9 cm H 2 O (6 to 12). With pneumoperitoneum, airway opening pressure increased up to 21 cm H 2 O (19 to 28) and end-expiratory lung volume remained unchanged (1,294 ml [1,154 to 1,363] vs. 1,160 ml [1,118 to 1,256], P = 0.155), because end-expiratory alveolar pressure increased consistently with airway opening pressure and counterbalanced pneumoperitoneum-induced increases in end-expiratory esophageal pressure (16 cm H 2 O [15 to 19] vs. 27 cm H 2 O [23 to 30], P = 0.005). Conversely, matched control subjects experienced a statistically significant greater reduction in end-expiratory lung volume due to pneumoperitoneum (1,113 ml [1,040 to 1,577] vs. 1,000 ml [821 to 1,061], P = 0.006). With airway closure, static/dynamic mechanics failed to measure actual lung/respiratory mechanics. When patients with airway closure underwent pressure-controlled ventilation, no tidal volume was inflated until inspiratory pressure overcame airway opening pressure.conclusions: In obese patients, complete airway closure is frequent during anesthesia and is worsened by Trendelenburg pneumoperitoneum, which increases airway opening pressure and alveolar pressure: besides preventing alveolar derecruitment, this yields misinterpretation of respiratory mechanics and generates a pressure threshold to inflate the lung that can reach high values, spreading concerns on the safety of pressure-controlled modes in this setting.

show abstract

Section: Discussionmentioning

confidence: 85%

“…Second, reported data are limited to 11 cases, and all patients were females, which cannot ensure the reproducibility of the findings among male patients. However, previous investigations in different settings 1,4,23 clearly showed that males may be similarly affected.…”

Section: Perioperative Medicinementioning

confidence: 89%

Airway Closure during Surgical Pneumoperitoneum in Obese Patients

Grieco¹,

Anzellotti²,

Russo³

et al. 2019

Anesthesiology

View full text Add to dashboard Cite

show abstract

“…During CPR, repetitive chest compressions result in a significant reduction in lung volumes below end expiratory lung volumes that may favor small airways closure and affect gas exchange 13,14 . Interestingly, airway closure has been also recently reported in ARDS patients 15 . Thus, CRALE could be the clinical result of the dynamic reduction of lung volumes occurring during CPR.…”

mentioning

confidence: 83%

Cardiopulmonary Resuscitation–associated Lung Edema: The Price to Pay to Get the Heartbeat?

Géri

Richard

2021

Am J Respir Crit Care Med

View full text Add to dashboard Cite

“…17 The same group also reported that end-tidal CO 2 influences proper alveolar ventilation, as it decreases in cases of alveoli closure despite a satisfactory hemodynamic effect of chest compressions. 18 On the other hand, PEEP increases the risk of dynamic hyperinflation (and is associated with important hemodynamic effects); this can, in turn, cause a reduction in venous return and, therefore, cardiac output (under conditions of preload-dependent cardiac stroke). 19 As long ago as 1980, Babbs and co workers noted that applying positive airway pressure during chest compressions increased oxygenation without deteriorating cardiac function.…”

Section: Peepmentioning

confidence: 99%

Mechanical Ventilation Management During Mechanical Chest Compressions

et al. 2020

View full text Add to dashboard Cite

Intrathoracic Airway Closure Impacts CO₂ Signal and Delivered Ventilation during Cardiopulmonary Resuscitation

Cited by 53 publications

References 46 publications

Airway Closure during Surgical Pneumoperitoneum in Obese Patients

Airway Closure during Surgical Pneumoperitoneum in Obese Patients

Cardiopulmonary Resuscitation–associated Lung Edema: The Price to Pay to Get the Heartbeat?

Mechanical Ventilation Management During Mechanical Chest Compressions

Contact Info

Product

Resources

About

Intrathoracic Airway Closure Impacts CO2 Signal and Delivered Ventilation during Cardiopulmonary Resuscitation

Cited by 53 publications

References 46 publications

Airway Closure during Surgical Pneumoperitoneum in Obese Patients

Airway Closure during Surgical Pneumoperitoneum in Obese Patients

Cardiopulmonary Resuscitation–associated Lung Edema: The Price to Pay to Get the Heartbeat?

Mechanical Ventilation Management During Mechanical Chest Compressions

Contact Info

Product

Resources

About

Intrathoracic Airway Closure Impacts CO₂ Signal and Delivered Ventilation during Cardiopulmonary Resuscitation