Positive end‐expiratory pressure optimization using electric impedance tomography in morbidly obese patients during laparoscopic gastric bypass surgery

Abstract

Background: Morbidly obese patients have an increased risk for peri-operative lung complications and develop a decrease in functional residual capacity (FRC). Electric impedance tomography (EIT) can be used for continuous, fast-response measurement of lung volume changes. This method was used to optimize positive end-expiratory pressure (PEEP) to maintain FRC. Methods: Fifteen patients with a body mass index of 49 AE 8 kg/m

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

“…Ventilation strategies The effects of intraoperative intermittent positive pressure ventilation (IPPV) regimens on physiological variables are reported in bariatric patients [114][115][116][117][118]. Currently, the translation of these data into effects on postoperative pulmonary complications and outcomes is lacking for the bariatric population.…”

Regional lung derecruitment after endotracheal suction during volume- or pressure-controlled ventilation: a study using electric impedance tomography

“…The nitrogen washout/washin method for FRC measurements used (Papers III and IV) is new but promising and evaluated in a number of studies [87,92]. It is computerized and currently in clinical use, incorporated into modern ventilators and therefore suitable for our studies.…”

“…The devices used in Study III and IV are research prototypes. They have been evaluated a few studies [85,87,102]. It is at present the only radiation free, bedside tool for continuous monitoring of global and regional changes in EELV in contrast to the CT technique.…”

“…I:E was set to 1:2 and triggering sensitivity -2 cmH 2 O and volume calibration for EIT tidal changes performed by stepwise changing the tidal volume by 100 ml at three levels [87]. During the suctioning procedure, either VCV or PCV was used with patient's baseline tidal volume, RR and PEEP.…”

Optimizing Perioperative Ventilation Support with Adequate Settings of Positive End-Expiratory Pressure

“…In the past three decades, a multitude of physicians and scientists dedicated themselves to identify the best PEEP levels for patients under surgeries (Beiderlinden et al, 2003, Berendes et al, 1996, Bensenor et al, 2007, as well as patients with variable diseases, such as ALI or ARDS (Badet et al, 2009, Huh et al, 2009, morbid obesity (Bohm et al, 2009, Erlandsson et al, 2006, chronic obstructive pulmonary disease (COPD) (Glerant et al, 2005, Mancebo et al, 2000, brain-injury (Shapiro andMarshall, 1978, Huynh et al, 2002), including infants (Greenough et al, 1992, Dimitriou et al, 1999. Although different terminologies and endpoints for optimizing PEEP were used (Villar, 2005), most of the approaches tried to obtain the best oxygenation while minimizing VILI as outcome.…”