Optimal <scp>PEEP</scp> during one‐lung ventilation with capnothorax: An experimental study

Reinius, Henrik; Borges, João Batista; Engström, Joakim; Ahlgren, Oskar; Lennmyr, Fredrik; Larsson, Anders; Fredén, Filip

doi:10.1111/aas.13247

Cited by 11 publications

(10 citation statements)

References 37 publications

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“…Once inflammatory factors are out of balance, they will lead to serious adverse consequences. IL-10 is an anti-inflammatory and immunosuppressive factor that inhibits the release of proinflammatory mediators such as IL-6 and TNF-α[ 20 ]. The results of this study showed that at 4 h after surgery, the measured values of TNF-α and IL-6 in group A were lower than those in group B, and the differences were significant ( P < 0.05).…”

Section: Discussionmentioning

confidence: 99%

Different positive end expiratory pressure and tidal volume controls on lung protection and inflammatory factors during surgical anesthesia

Wang¹,

Yang²,

Wang³

et al. 2022

World J Clin Cases

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BACKGROUND Mechanical ventilation can lead to the severe impairment of the metabolic pathway of alveolar surfactants, inactivating alveolar surfactants and significantly reducing lung-chest compliance. The cardiopulmonary function of elderly patients usually reduced to a certain extent, and there are lung complications after surgical anesthesia, just like lung barotrauma caused by mechanical ventilation, atelectasis and postoperative hypoxemia. AIM To investigate the effects of different positive end expiratory pressures (PEEPs) and tidal volumes (VTs) on respiratory function, the degree of the inflammatory response and hemodynamic indexes in patients undergoing surgery under general anesthesia. METHODS A total of 120 patients undergoing surgery for gastric or colon cancer under general anesthesia in Xinghua People's Hospital from January 2017 to January 2021 were randomly divided into Group A and Group B, with 60 cases in each group. The ventilation mode in Group A was VT (6.0 mL/kg) + PEEP (5.0 cmH 2 O), while that in Group B was VT (6.0 mL/kg) + PEEP (8.0 cmH 2 O). Blood gas parameters, respiratory mechanical parameters, inflammatory response indicators, hemodynamic indicators and related complications were compared between the two groups. RESULTS There were no significant differences in PaCO 2 , PaO 2 , oxygen or the examined indexes at T0 between group A and group B ( P > 0.05). The measured PaO 2 value of patients in group A at T3 was higher than that in group B, and the difference was significant ( P < 0.05). There were no significant differences in peak airway pressure (P peak ), mean airway pressure or dynamic pulmonary compliance (Cdyn) at T0 between group A and group B ( P > 0.05). The measured P peak value of patients in group A at T1 was higher than that in group B, and the difference was significant ( P < 0.05). The measured Cdyn value at T1 and T2 was greater than that in group B ( P < 0.05). Before surgery, there were no significant differences in tumor necrosis factor-α (TNF-α), interleukin (IL)-6 or IL-10 between group A and group B ( P > 0.05). After 4 h, the measured values of TNF-α and IL-6 in group A were lower than those in group B, and the differences were significant ( P < 0.05). The IL-10 Level in group A was higher than that in group B ( P < 0.05). At T0, there were no significant differences in cardiac output, cardiac index (CI), stroke volume index (SVI) or mean arterial pressure between group A and group B ( P > 0.05). The measured values of CI and SVI at T...

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Section: Discussionmentioning

confidence: 99%

Different positive end expiratory pressure and tidal volume controls on lung protection and inflammatory factors during surgical anesthesia

Wang¹,

Yang²,

Wang³

et al. 2022

World J Clin Cases

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“…An animal experiment also confirmed the importance of individualized PEEP, in which Reiniush et al obtained the appropriate range of PEEP according to oxygenation, driving pressure and cardiac output. PEEP exceeded this range would cause ventilation/perfusion mismatch of the ventilated lung 111 . The optimal PEEP remains a matter of considerable debate.…”

Section: Explore the Optimal Individualized Peep Valuementioning

confidence: 99%

“…PEEP exceeded this range would cause ventilation/perfusion mismatch of the ventilated lung. 111 The optimal PEEP remains a matter of considerable debate. This uncertainty has fostered various setting approaches.…”

Section: Explore the Optimal Individualized Peep Valuementioning

confidence: 99%

A structured narrative review of clinical and experimental studies of the use of different positive end‐expiratory pressure levels during thoracic surgery

Yueyi

Tan

2022

Clinical Respiratory J

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Objectives This study aimed to present a review on the general effects of different positive end‐expiratory pressure (PEEP) levels during thoracic surgery by qualitatively categorizing the effects into detrimental, beneficial, and inconclusive. Data source Literature search of Pubmed, CNKI, and Wanfang was made to find relative articles about PEEP levels during thoracic surgery. We used the following keywords as one‐lung ventilation, PEEP, and thoracic surgery. Results We divide the non‐individualized PEEP value into five grades, that is, less than 5, 5, 5–10, 10, and more than 10 cmH2O, among which 5 cmH2O is the most commonly used in clinic at present to maintain alveolar dilatation and reduce the shunt fraction and the occurrence of atelectasis, whereas individualized PEEP, adjusted by test titration or imaging method to adapt to patients' personal characteristics, can effectively ameliorate intraoperative oxygenation and obtain optimal pulmonary compliance and better indexes relating to respiratory mechanics. Conclusions Available data suggest that PEEP might play an important role in one‐lung ventilation, the understanding of which will help in exploring a simple and economical method to set the appropriate PEEP level.

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“…Reversal of atelectasis by PEEP improves the oxygenation by decreasing shunt and improves the mechanical properties of the ventilated lung (12). Conversely, use of excessive PEEP might induce lung overdistension and increase regional PVR.…”

Section: Peepmentioning

confidence: 99%

Cardio-respiratory physiology during one-lung ventilation: complex interactions in need of advanced monitoring

Marongiu¹,

Spinelli²,

Mauri³

2020

Ann Transl Med

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Optimal PEEP during one‐lung ventilation with capnothorax: An experimental study

Abstract: Optimal PEEP was 12-18 cm H O and probably relates to capnothorax insufflation pressure. With suboptimal PEEP, ventilation/perfusion mismatch in the ventilated lung and redistribution of blood flow to the nonventilated lung occurred.

Cited by 11 publications

References 37 publications

Different positive end expiratory pressure and tidal volume controls on lung protection and inflammatory factors during surgical anesthesia

Different positive end expiratory pressure and tidal volume controls on lung protection and inflammatory factors during surgical anesthesia

A structured narrative review of clinical and experimental studies of the use of different positive end‐expiratory pressure levels during thoracic surgery

Cardio-respiratory physiology during one-lung ventilation: complex interactions in need of advanced monitoring

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