Changes in stroke volume during an alveolar recruitment maneuvers through a stepwise increase in positive end expiratory pressure and transient continuous positive airway pressure in anesthetized patients. A prospective observational pilot study

Autor:	Dorothée Radenac, Jean Louis Gérard, Jean-Luc Hanouz, Christophe Persyn, Marc Olivier Fischer, Axel Coquerel
Jazyk:	angličtina
Rok vydání:	2019
Předmět:	medicine.medical_specialty medicine.medical_treatment Alveolar recruitment Hemodynamics lcsh:RS1-441 anesthesia lcsh:RD78.3-87.3 lcsh:Pharmacy and materia medica 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Internal medicine medicine Pharmacology (medical) Continuous positive airway pressure General Pharmacology Toxicology and Pharmaceutics Positive end-expiratory pressure business.industry ventilation 030208 emergency & critical care medicine Stroke volume Perioperative Pulse pressure Preload esophageal doppler Anesthesiology and Pain Medicine Blood pressure lcsh:Anesthesiology positive end expiratory pressure stroke volume Cardiology Original Article business circulatory and respiratory physiology
Zdroj:	Journal of Anaesthesiology, Clinical Pharmacology Journal of Anaesthesiology Clinical Pharmacology, Vol 35, Iss 4, Pp 453-459 (2019)
ISSN:	2231-2730 0970-9185
Popis:	Background and Aims: Recruitment maneuvers may be used during anesthesia as part of perioperative protective ventilation strategy. However, the hemodynamic effect of recruitment maneuvers remain poorly documented in this setting. Material and Methods: This was a prospective observational study performed in operating theatre including patients scheduled for major vascular surgery. Patients were monitored with invasive arterial pressure and esophageal doppler. After induction of general anesthesia, before surgery began, preload optimization based on stroke volume (SV) variation following fluid challenge was performed. Then, an alveolar recruitment maneuver (ARM) through stepwise increase in positive end expiratory pressure (PEEP) or continuous positive airway pressure (CPAP) was performed. Hemodynamic data were noted before, during, and after the alveolar recruitment maneuver. Results: ARM through stepwise increase in PEEP and CPAP were applied in 22 and 14 preload independent patients, respectively. Relative changes in SV during ARMs were significantly greater in the ARMCPAP group (-39 ± 20%) as compared to the ARMPEEP group (-15 ± 22%; P = 0.002). The difference (95% CI) in relative decrease in SV between ARMCPAP and ARMPEEP groups was -24% (-38 to -9; P = 0.001). Changes in arterial pressure, cardiac index, pulse pressure variation, peak velocity, and corrected flow time measures were not different between groups. Conclusion: During anesthesia, in preload independent patients, ARMs through CPAP resulted in a significantly greater decrease in SV than stepwise increase in PEEP. During anesthesia, ARM should be used cautiously.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4b0262dc257969cccae413fca08c3967 http://europepmc.org/articles/PMC6939576 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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