Open lung approach versus standard protective strategies: Effects on driving pressure and ventilatory efficiency during anesthesia - A pilot, randomized controlled trial
| Autor: | Natividad Pozo, Estefania Gracia, Francisco Javier Belda, Carlos Ferrando, Gerardo Tusman, Irene León, Marina Soro, Blanca Arocas, Esther Romero, Fernando Suarez-Sipmann, Ana Mugarra |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Medicin och hälsovetenskap Pulmonology Respiratory System lcsh:Medicine Pulmonary Function Hemodynamics Medical and Health Sciences law.invention Positive-Pressure Respiration 0302 clinical medicine Randomized controlled trial Anesthesiology 030202 anesthesiology law Medicine and Health Sciences Pressure Anesthesia Medicine Anesthesia Lung volumes 030212 general & internal medicine lcsh:Science Lung Tidal volume Capnography Multidisciplinary medicine.diagnostic_test Pharmaceutics Middle Aged respiratory system medicine.anatomical_structure Abdominal Surgery Female Anatomy circulatory and respiratory physiology Research Article Surgical and Invasive Medical Procedures Respiratory physiology Lung injury 03 medical and health sciences Drug Therapy Tidal Volume Humans Aged business.industry lcsh:R Biology and Life Sciences respiratory tract diseases lcsh:Q Local and Regional Anesthesia Lungs business |
| Zdroj: | PLoS ONE PLoS ONE, Vol 12, Iss 5, p e0177399 (2017) |
| ISSN: | 1932-6203 |
| Popis: | BACKGROUND:Low tidal volume (VT) during anesthesia minimizes lung injury but may be associated to a decrease in functional lung volume impairing lung mechanics and efficiency. Lung recruitment (RM) can restore lung volume but this may critically depend on the post-RM selected PEEP. This study was a randomized, two parallel arm, open study whose primary outcome was to compare the effects on driving pressure of adding a RM to low-VT ventilation, with or without an individualized post-RM PEEP in patients without known previous lung disease during anesthesia. METHODS:Consecutive patients scheduled for major abdominal surgery were submitted to low-VT ventilation (6 ml·kg-1) and standard PEEP of 5 cmH2O (pre-RM, n = 36). After 30 min estabilization all patients received a RM and were randomly allocated to either continue with the same PEEP (RM-5 group, n = 18) or to an individualized open-lung PEEP (OL-PEEP) (Open Lung Approach, OLA group, n = 18) defined as the level resulting in maximal Cdyn during a decremental PEEP trial. We compared the effects on driving pressure and lung efficiency measured by volumetric capnography. RESULTS:OL-PEEP was found at 8±2 cmH2O. 36 patients were included in the final analysis. When compared with pre-RM, OLA resulted in a 22% increase in compliance and a 28% decrease in driving pressure when compared to pre-RM. These parameters did not improve in the RM-5. The trend of the DP was significantly different between the OLA and RM-5 groups (p = 0.002). VDalv/VTalv was significantly lower in the OLA group after the RM (p = 0.035). CONCLUSIONS:Lung recruitment applied during low-VT ventilation improves driving pressure and lung efficiency only when applied as an open-lung strategy with an individualized PEEP in patients without lung diseases undergoing major abdominal surgery. TRIAL REGISTRATION:ClinicalTrials.gov NCT02798133. |
| Databáze: | OpenAIRE |
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