The Function of Each Lung of Anesthetized and Paralyzed Man during Mechanical Ventilation

Rehder, Kai; Hatch, D. J.; Sessler, Alan D.; Fowler, Ward S.

doi:10.1097/00000542-197207000-00004

Cited by 120 publications

(32 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, atelectasis commonly occurs in patient without secretions and with normal lungs [25]. On the other hand, anaesthesia is accompanied by a reduction of the rib cage excursions [26], right shift of the pressure-volume curve (reduced "expansion pressure") [27], early airways closure [28], and redistribution of ventilation to the upper lung zones [29]. The increased airway resistance (Raw) [30] is probably merely reflecting the reduced FRC, which in normal subjects is very close to relaxation volume (Vr) of the respiratory system.…”

Section: Discussionmentioning

confidence: 99%

Upper abdominal surgery: does a lung function test exist to predict early severe postoperative respiratory complications?

Barisione¹,

Rovida²,

Gazzaniga³

et al. 1997

Eur Respir J

View full text Add to dashboard Cite

We evaluated the capacity to predict severe respiratory complications (SRCs) following upper abdominal surgery (UAS) by using the results of a respiratory questionnaire and preoperative pulmonary function tests.Lung volumes, flows and transfer factor of the lung for carbon monoxide (TL,CO,sb) were assessed in 361 consecutive adult patients (248 males and 113 females). SRCs were diagnosed 24 h after UAS by clinical examination and chest radiography. Univariate and stepwise multiple logistic regression analyses were performed to estimate the odds ratio (OR) and 95% confidence interval (95% CI) of each single input variable, and to determine which indices best predicted outcome.These patients had a 1% mortality rate and 14% incidence of SRCs, with a male:female ratio of 0.86. The best predictors for SRCs by multiple analysis were: preoperative current hypersecretion of mucus (OR=133; p<0.0001); an increase in residual volume (RV) (OR=3.11; p=0.01); and, to a lesser extent, low percentage of predicted values both of forced expiratory volume in one second (FEV1 % pred) and TL,CO,sb. The algorithm thus obtained (logit θ) was extremely sensitive (84%), specific (99%), and accurate (95%) for preoperative prediction of SRCs.We have found that preoperative current hypersecretion of mucus and pulmonary hyperinflation, and to a lesser extent percentage predicted values both of forced expiratory volume in one second and transfer factor of the lung for carbon monoxide, have a significant predictive capacity for severe respiratory complications following upper abdominal surgery. Eur Respir J 1997; 10: 1301-1308 Since 1910, it has been well-known that patients undergoing upper abdominal surgery (UAS) generally develop a severe pulmonary restrictive pattern [1], and carry a high risk of postoperative respiratory complications [2][3][4]. The most important factors determining the degree of postoperative impairment of ventilation and gas exchange are the site of operation, the age, and clinical status of the patient [5]. Forced vital capacity (FVC) and peak flows are often reduced to half, and the functional residual capacity (FRC) to below 70% of the preoperative values [5]. These effects may not be restored even by the fifth postoperative day [5]. The reduced FVC and the reduction of FRC are mainly a consequence of an impaired diaphragmatic function [6]. Furthermore, the risk for postoperative respiratory complications decreases with the distance of the surgical incision from the diaphragm [7,8].Several studies have tried to determine the incidence of postoperative respiratory complications of UAS, and the estimates vary widely. The majority of investigations have focused on subclinical complications, i.e. radiographic evidence of atelectasis, with or without pleural fluid. With this broader definition of complication, the incidence of postoperative complications of UAS is approximately 25-75% [9,10].In this paper, we examine the relationship between preoperative respiratory symptoms and physiology, and postoperative r...

show abstract

Section: Discussionmentioning

confidence: 99%

Upper abdominal surgery: does a lung function test exist to predict early severe postoperative respiratory complications?

Barisione¹,

Rovida²,

Gazzaniga³

et al. 1997

Eur Respir J

View full text Add to dashboard Cite

show abstract

“…As a result, the positive pressure preferentially dis places the nondependent region of the diaphragm where the abdominal pressure is lower. Furthermore, in the lat eral position, the compliance of the dependent hemithorax is less than that of the nondependent [9,10], Thus in artificially ventilated patients, such as our case, the upper part of the lung is relatively more ventilated than the low er one.…”

Section: Discussionmentioning

confidence: 63%

Effect of Changing Position on Arterial Oxygenation in a Patient with Agenesia of the Left Pulmonary Artery

Ferrari

Karrazi²,

Lampronti³

et al. 1997

Respiration

View full text Add to dashboard Cite

The effects of body position (supine, right and left lateral decubitus) on gas exchange were evaluated in a patient with agenesis of the left pulmonary artery, subjected to mechanical ventilation because of adult respiratory distress syndrome. Arterial blood gases were measured 60 min after each of the three positions was attained and showed that lying on the left side (i.e. the side of the impaired lung) produced higher arterial oxygen pressure (68.5 ± 1.5 mm Hg) than lying on the opposite side (50.0 ± 1.2 mm Hg); (p < 0.05). No significant differences in mean arterial carbon dioxide pressure were found. In contrast to unilateral lung diseases affecting the parenchyma, the position improving arterial oxygenation was the one in which the healthy lung was uppermost, in our patient with a unilateral perfusion defect.

show abstract

“…[19] In ventilated, sedated and paralyzed patients, the alveolar ventilation of dependent worse lung remains poor due to its low compliance but there is preferential perfusion under gravity. [18,20,21] Thus the ventilation-perfusion mismatch adds to right-to-left shunt and reduced oxygenation in patients with unilateral lung disease. [22,23] In ARDS patients, diffuse and bilateral inÞ ltrates in chest x-ray still represent a patchy lung atelectasis due to varied grades of the lung's disease.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of lung infiltration score to predict postural hypoxemia in ventilated acute respiratory distress syndrome patients and the lateralization of skin pressure sore

et al. 2009

View full text Add to dashboard Cite

The Function of Each Lung of Anesthetized and Paralyzed Man during Mechanical Ventilation

Cited by 120 publications

References 0 publications

Upper abdominal surgery: does a lung function test exist to predict early severe postoperative respiratory complications?

Upper abdominal surgery: does a lung function test exist to predict early severe postoperative respiratory complications?

Effect of Changing Position on Arterial Oxygenation in a Patient with Agenesia of the Left Pulmonary Artery

Evaluation of lung infiltration score to predict postural hypoxemia in ventilated acute respiratory distress syndrome patients and the lateralization of skin pressure sore

Contact Info

Product

Resources

About