Positive end‐expiratory pressure prevents atelectasisduring general anaesthesia even in the presence of a high inspired oxygen concentration

Neumann, Peter; Rothen, H. U.; Berglund, Johan; Valtysson, Johann; Magnusson, Anders; Hedenstierna, Göran

doi:10.1034/j.1399-6576.1999.430309.x

Cited by 201 publications

(133 citation statements)

References 18 publications

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“…No entanto, essas áreas podem reaparecer dentro de alguns minutos se for utilizado oxigênio a 100%, mas isso não ocorre ser for aplicado simultaneamente uma PEEP igual a 10cm H 2 O. Assim, a MCV seguida por PEEP de 10cm H 2 O deve ser utilizada quando pacientes são ventilados com altas frações de oxigênio inspirado e quando a troca gasosa estiver prejudicada (NEUMANN et al, 1999).…”

Section: Fatores Relacionados a áReas De Atelectasiaunclassified

Atelectasia pulmonar em cães durante anestesia geral

Lopes

Nunes

2009

Cienc. Rural

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Section: Fatores Relacionados a áReas De Atelectasiaunclassified

Atelectasia pulmonar em cães durante anestesia geral

Lopes

Nunes

2009

Cienc. Rural

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“…Certamente, a utilização de volumes correntes elevados (> 10 mL.kg -1 ) não promove proteção contra colapso pulmonar e pode exacerbar lesão pulmonar associada à ventilação mecânica, não devendo ser empregados na prática clínica 45,46 . A não-utilização de PEEP durante a ventilação mecânica, em paciente submetido à anestesia geral com frações elevadas de oxigênio mesmo em associação a volumes correntes grandes é fator importante na formação de colapso pulmonar intra-operatório 47 . Nos pacientes submetidos à intervenção cirúrgica cardíaca, o uso de circulação extracorpórea, independente da esternotomia e manipulação torácica, é fator relacionado com o desenvolvimento de atelectasias intra-operatórias.…”

Section: Mecanismos Do Colapso Pulmonar Intra-operatóriounclassified

“…Certainly, the use of elevated tidal volumes (> 10 mL.kg -1 ) does not offer protection against pulmonary collapse and it can exacerbate pulmonary lesions associated with mechanical ventilation, and, therefore, should not be used in clinical practice 45,46 . The lack of PEEP during mechanical ventilation of patients undergoing general anesthesia with high inspired fraction of oxygen, even when associated with large tidal volumes, is an important factor for the development of intraoperative pulmonary collapse 47 . In patients undergoing cardiac surgeries, the use of cardiopulmonary bypass, independently of the sternectomy and thoracic manipulation, is related with the development of intraoperative atelectasis.…”

Section: Mechanisms Of Intraoperative Pulmonary Collapsementioning

confidence: 99%

Atelectasias durante anestesia: fisiopatologia e tratamento

Malbouisson¹,

Humberto²,

Rodrigues³

et al. 2008

Rev. Bras. Anestesiol.

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Rev Bras AnestesiolARTIGO DE REVISÃO 2008; 58: 1: 73-83 REVIEW ARTICLE RESUMOMalbouisson LMS, Humberto F, Rodrigues RR, Carmona MJC, Auler Jr JOC -Atelectasias durante Anestesia: Fisiopatologia e Tratamento. JUSTIFICATIVA E OBJETIVOS:O colapso pulmonar intra-operatório é uma complicação de elevada incidência em pacientes submetidos à intervenção cirúrgica sob anestesia geral com relaxamento/paralisia da musculatura. Essa complicação está associada à piora das trocas gasosas no intra-operatório e, em alguns casos, necessidade de suporte respiratório prolongado no perío-do pós-operatório. Os objetivos deste estudo foram revisar os aspectos fisiopatológicos da formação de atelectasias durante anestesia geral e as possíveis manobras terapêuticas para prevenir e tratar essa complicação.CONTEÚDO: Nesta revisão, os conceitos sobre a incidência de atelectasias intra-operatórias, os fatores relacionados com o seu desenvolvimento, tanto mecânicos quanto associados ao ajuste do respirador durante procedimento cirúrgico, os aspectos do diagnós-tico e as estratégias de prevenção e tratamento foram abordados de maneira sistemática. CONCLUSÕES:A compreensão dos mecanismos relacionados com o desenvolvimento do colapso pulmonar durante o período intra-operatório, assim como o seu tratamento, pode contribuir para a redução da incidência de complicações pulmonares pós-operatórias, o tempo de recuperação e os custos hospitalares.Unitermos: COMPLICAÇÕES: atelectasia; colapso pulmonar; VEN-TILAÇÃO: controlada mecânica, manobra de recrutamento alveolar, pressão positiva ao final da expiração. SUMMARYMalbouisson LMS, Humberto F, Rodrigues RR, Carmona MJC, Auler Jr JOC -Atelectasis During Anesthesia: Pathophysiology and Treatment. BACKGROUND AND METHODS:The incidence of intraoperative pulmonary collapse is elevated in patients undergoing surgery under general anesthesia with muscle relaxation/paralysis. This complication is associated with worsening intraoperative gas exchange and, in some cases, the need for prolonged postoperative respiratory support. The objective of this report was to review the pathophysiological aspects of atelectasis during general anesthesia and possible therapeutic maneuvers that could prevent and treat this complication. CONTENTS:This review discusses the concepts about the incidence of intraoperative atelectasis, factors that influence their development, both mechanical and those related to mechanical ventilator settings during the surgery, diagnostic criteria, and strategies to prevent and treat this complication. CONCLUSIONS:Understanding of the mechanisms related with the development of intraoperative pulmonary collapse, as well as its treatment, can contribute to reduce the incidence of postoperative pulmonary complications, the length of recovery and hospital costs.

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“…A stepwise incremental and decremental PIP and PEEP titration 2. Sustained hyperinflation of the lung during one or more breaths followed by a pre-determined level of PEEP (Neumann et al 1999). …”

Section: Introductionmentioning

confidence: 99%

The use of positive end-expiratory pressure (PEEP) and alveolar recruitment manoeuvre (ARM) in equine anaesthesia – a review

Küls¹,

Braun²,

Moens³

2016

PHK

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Summary: Impairment of gas exchange and arterial oxygenation during general anaesthesia and recumbency of the horse are a common and well-known problem. Often these alterations are poorly responsive to intermittent positive pressure ventilation (IPPV) and increasing levels of supplemental oxygen. Over the last decades the understanding of the underlying pathophysiology developed more and more, recognizing that a decrease in functional residual capacity (FRC), lung collapse and atelectasis, and ultimately ventilation/perfusion mismatch lead to poor oxygenation. Accordingly, new ventilation strategies arose over the course of time including alveolar recruitment manoeuvres (ARMs) and positive end expiratory pressure (PEEP). In 1992 Burkhard Lachmann presented his idea of an 'open lung' concept using high peak inspiratory pressures to reopen atelectatic lung regions followed by sufficiently high PEEP to keep the recruited lung areas open. In equine anaesthesia, early attempts with continuous positive pressure in spontaneously breathing horses yielded rather disappointing results. In combination with IPPV the use of PEEP resulted in unreliable improvements in the partial pressure of oxygen in arterial blood (PaO 2 ). Once the pre-treatment with an ARM prior to PEEP was introduced, improvement in PaO 2 could be seen to be more reliable. Despite these promising results, there is a risk of adverse effects with the use of PEEP and ARM in horses due to the high pressures that are necessary to achieve an effect. A reduction in cardiac output proportional to the increase in intrathoracic pressure has been observed and may compromise peripheral blood flow as well as gastrointestinal perfusion once a certain pressure threshold is reached. Similar, an increase in right to left shunt due to forcing blood into already collapsed lung areas can compromise the desired effect. Finally, early signs of ventilator induced lung injury have been detected in horses and it remains to be seen how future ventilation strategies will succeed in finding the optimal balance for each individual horse. This review presents the development and use of ARMs and PEEP in horses and its potential effect and side effects.

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Positive end‐expiratory pressure prevents atelectasisduring general anaesthesia even in the presence of a high inspired oxygen concentration

Abstract: PEEP = 10 cmH2O reduced atelectasis formation after a VCM, when FiO2 = 1.0 was used. Thus, a VCM followed by PEEP = 10 cmH2O should be considered when patients are ventilated with a high FiO2 and gas exchange is impaired.

Cited by 201 publications

References 18 publications

Atelectasia pulmonar em cães durante anestesia geral

Atelectasia pulmonar em cães durante anestesia geral

Atelectasias durante anestesia: fisiopatologia e tratamento

The use of positive end-expiratory pressure (PEEP) and alveolar recruitment manoeuvre (ARM) in equine anaesthesia – a review

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