101
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Review of hypoxaemia in anaesthetized horses: predisposing factors, consequences and management. Vet Anaesth Analg 2017; 44:397-408. [DOI: 10.1016/j.vaa.2016.06.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 05/18/2016] [Accepted: 06/02/2016] [Indexed: 11/24/2022]
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102
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Xu Z, Gu L, Bian Q, Li P, Wang L, Zhang J, Qian Y. Oxygenation, inflammatory response and lung injury during one lung ventilation in rabbits using inspired oxygen fraction of 0.6 vs. 1.0. J Biomed Res 2017; 31:56-64. [PMID: 28808186 PMCID: PMC5274513 DOI: 10.7555/jbr.31.20160108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Maintaining adequate oxygenation during one-lung ventilation (OLV) requires high inspired oxygen fraction (FiO2). However, high FiO2 also causes inflammatory response and lung injury. Therefore, it remains a great interest to clinicians and scientists to optimize the care of patients undergoing OLV. The aim of this study was to determine and compare oxygenation, inflammatory response and lung injury during OLV in rabbits using FiO2 of 0.6 vs. 1.0. After 30 minutes of two-lung ventilation (TLV) as baseline, 30 rabbits were randomly assigned to three groups receiving mechanical ventilation for 3 hours: the sham group, receiving TLV with 0.6 FiO2; the 1.0 FiO2 group, receiving OLV with 1.0 FiO2; the 0.6 FiO2 group, receiving OLV with 0.6 FiO2. Pulse oximetry was continuously monitored and arterial blood gas analysis was intermittently conducted. Histopathologic study of lung tissues was performed and inflammatory cytokines and the mRNA and protein of nuclear factor kappa B (NF-κB) p65 were determined. Three of the 10 rabbits in the 0.6 FiO2 group suffered hypoxemia, defined by pulse oximetric saturation (SpO2) less than 90%. Partial pressure of oxygen (PaO2), acute lung injury (ALI) score, myeloperoxidase (MPO), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), mRNA and protein of NF-κB p65 were lower in the 0.6 FiO2 group than in the 1.0 FiO2 group. In conclusion, during OLV, if FiO2 of 0.6 can be tolerated, lung injury associated with high FiO2 can be minimized. Further study is needed to validate this finding in human subjects.
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Affiliation(s)
- Zeping Xu
- Department of Anesthesiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China.,Departments of Anesthesiology, Jiangsu Cancer Hospital, Nanjing Medical University, Nanjing, Jiangsu 210009, China
| | - Lianbing Gu
- Departments of Anesthesiology, Nanjing Medical University, Nanjing, Jiangsu 210009, China
| | - Qingming Bian
- Departments of Anesthesiology, Nanjing Medical University, Nanjing, Jiangsu 210009, China
| | - Pengyi Li
- Departments of Anesthesiology, Nanjing Medical University, Nanjing, Jiangsu 210009, China
| | - Lijun Wang
- Departments of Anesthesiology, Nanjing Medical University, Nanjing, Jiangsu 210009, China
| | - Jingyuan Zhang
- Pathology, Jiangsu Cancer Hospital, Nanjing Medical University, Nanjing, Jiangsu 210009, China
| | - Yanning Qian
- Department of Anesthesiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
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103
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Tusman G, Bohm SH, Suarez-Sipmann F. Advanced Uses of Pulse Oximetry for Monitoring Mechanically Ventilated Patients. Anesth Analg 2017; 124:62-71. [DOI: 10.1213/ane.0000000000001283] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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104
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Lascola KM, Clark-Price SC, Joslyn SK, Mitchell MA, O'Brien RT, Hartman SK, Kline KH. Use of manual alveolar recruitment maneuvers to eliminate atelectasis artifacts identified during thoracic computed tomography of healthy neonatal foals. Am J Vet Res 2016; 77:1276-1287. [PMID: 27805443 DOI: 10.2460/ajvr.77.11.1276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate use of single manual alveolar recruitment maneuvers (ARMs) to eliminate atelectasis during CT of anesthetized foals. ANIMALS 6 neonatal Standardbred foals. PROCEDURES Thoracic CT was performed on spontaneously breathing anesthetized foals positioned in sternal (n = 3) or dorsal (3) recumbency when foals were 24 to 36 hours old (time 1), 4 days old (time 2), 7 days old (time 3), and 10 days old (time 4). The CT images were collected without ARMs (all times) and during ARMs with an internal airway pressure of 10, 20, and 30 cm H2O (times 2 and 3). Quantitative analysis of CT images measured whole lung and regional changes in attenuation or volume with ARMs. RESULTS Increased attenuation and an alveolar pattern were most prominent in the dependent portion of the lungs. Subjectively, ARMs did not eliminate atelectasis; however, they did incrementally reduce attenuation, particularly in the nondependent portion of the lungs. Quantitative differences in lung attenuation attributable to position of foal were not identified. Lung attenuation decreased significantly (times 2 and 3) and lung volume increased significantly (times 2 and 3) after ARMs. Changes in attenuation and volume were most pronounced in the nondependent portion of the lungs and at ARMs of 20 and 30 cm H2O. CONCLUSIONS AND CLINICAL RELEVANCE Manual ARMs did not eliminate atelectasis but reduced attenuation in nondependent portions of the lungs. Positioning of foals in dorsal recumbency for CT may be appropriate when pathological changes in the ventral portion of the lungs are suspected.
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105
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Song IK, Kim EH, Lee JH, Ro S, Kim HS, Kim JT. Effects of an alveolar recruitment manoeuvre guided by lung ultrasound on anaesthesia-induced atelectasis in infants: a randomised, controlled trial. Anaesthesia 2016; 72:214-222. [DOI: 10.1111/anae.13713] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2016] [Indexed: 01/06/2023]
Affiliation(s)
- I.-K. Song
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - E.-H. Kim
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - J.-H. Lee
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - S. Ro
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - H.-S. Kim
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - J.-T. Kim
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
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106
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Arai YCP, Kawanishi J, Sakakima Y, Ohmoto K, Ito A, Maruyama Y, Ikemoto T. Severe Respiratory Event Initially Thought to be Inadvertent Endobronchial Intubation: Possible Complications From Using of a Topical Metered-Dose of 8% Lidocaine Pump Spray. Anesth Pain Med 2016; 6:e33771. [PMID: 27642575 PMCID: PMC5018134 DOI: 10.5812/aapm.33771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/11/2015] [Accepted: 12/09/2015] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Pulmonary collapse after intubation is common, and it is caused by a variety of factors. CASE PRESENTATION A 21-year-old man presented at our operation room to undergo an appendectomy. Except for a history of cigarette smoking, his history was negative. Anesthesia was induced with 100% oxygen and sevoflurane, remifentanil infusion, and propofol. Neuromuscular block was obtained with rocuronium. The tip and cuff of a tracheal tube were lubricated with a topical metered-dose of 8% Lidocaine pump spray. After intubation, SPO2 suddenly decreased. The chest x-ray revealed right upper lobe atelectasis. Fiber optic bronchoscopy showed that a large amount of yellow sticky mucus had been secreted into the right main bronchus. CONCLUSIONS In Japan, 8% Lidocaine pump spray contains menthol and ethanol as additives. These additives, particularly menthol, might have led to excessive mucus production, although we did not analyze the mucus secretion.
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Affiliation(s)
- Young-Chang P. Arai
- Department of Surgery, Toki General Hospital, Gifu, Japan
- Corresponding author: Young-Chang P. Arai, Multidisciplinary Pain Centre, School of Medicine, Aichi Medical University, Aichi, Japan. Tel: +81-561623311, Fax: +81-561625004, E-mail:
| | - Jun Kawanishi
- Department of Surgery, Toki General Hospital, Gifu, Japan
| | | | - Koichi Ohmoto
- Department of Surgery, Toki General Hospital, Gifu, Japan
| | - Akihiro Ito
- Department of Surgery, Toki General Hospital, Gifu, Japan
| | - Yuki Maruyama
- Department of Surgery, Toki General Hospital, Gifu, Japan
| | - Tatsunori Ikemoto
- Multidisciplinary Pain Centre, School of Medicine, Aichi Medical University, Aichi, Japan
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107
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Tusman G, Acosta CM, Costantini M. Ultrasonography for the assessment of lung recruitment maneuvers. Crit Ultrasound J 2016; 8:8. [PMID: 27496127 PMCID: PMC4975737 DOI: 10.1186/s13089-016-0045-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 07/27/2016] [Indexed: 02/07/2023] Open
Abstract
Lung collapse is a known complication that affects most of the patients undergoing positive pressure mechanical ventilation. Such atelectasis and airways closure lead to gas exchange and lung mechanics impairment and has the potential to develop an inflammatory response in the lungs. These negative effects of lung collapse can be reverted by a lung recruitment maneuver (RM) i.e. a ventilatory strategy that resolves lung collapse by a brief and controlled increment in airway pressures. However, an unsolved question is how to assess such RM at the bedside. The aim of this paper is to describe the usefulness of lung sonography (LUS) to conduct and personalize RM in a real-time way at the bedside. LUS has favorable features to assess lung recruitment due to its high specificity and sensitivity to detect lung collapse together with its non-invasiveness, availability and simple use.
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Affiliation(s)
- Gerardo Tusman
- Department of Anesthesiology, Hospital Privado de Comunidad, Córdoba 4545, 7600, Mar del Plata, Buenos Aires, Argentina.
| | - Cecilia M Acosta
- Department of Anesthesiology, Hospital Privado de Comunidad, Córdoba 4545, 7600, Mar del Plata, Buenos Aires, Argentina
| | - Mauro Costantini
- Department of Anesthesiology, Hospital Privado de Comunidad, Córdoba 4545, 7600, Mar del Plata, Buenos Aires, Argentina
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Pisani I, Comellini V, Nava S. Noninvasive ventilation versus oxygen therapy for the treatment of acute respiratory failure. Expert Rev Respir Med 2016; 10:813-21. [PMID: 27159196 DOI: 10.1080/17476348.2016.1184977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION There is an ongoing discussion on whether oxygen therapy or noninvasive ventilation (NIV) should be used in patient with acute respiratory failure. While respiratory acidosis, especially in case of COPD exacerbation, is a clear indication for NIV, data available in patients with acute hypoxemic respiratory failure (AHRF) are ambiguous. In addition, recently the use of nasal high flow (NHF) has been increased. Despite that NHF has been studied as an alternative to NIV, the clinical advantages of NHF need to be confirmed. AREAS COVERED The purpose of this review is to enhance our understanding about the management of AHRF in specific settings, focusing on recent papers in which NIV and standard oxygen or NHF have been compared. Expert commentary: The choice of the most appropriate strategy for AHRF treatment should be made based upon patient's clinical status, underlying diseases, level of required respiratory support and patient's tolerance and comfort.
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Affiliation(s)
- Iara Pisani
- a Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit , Alma Mater University , Bologna , Italy
| | - Vittoria Comellini
- a Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit , Alma Mater University , Bologna , Italy
| | - Stefano Nava
- a Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit , Alma Mater University , Bologna , Italy
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109
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Effect of low inspired oxygen fraction on respiratory indices in mechanically ventilated horses anaesthetised with isoflurane and medetomidine constant rate infusion. Vet J 2016; 211:70-4. [PMID: 27012166 DOI: 10.1016/j.tvjl.2016.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 02/17/2016] [Accepted: 02/18/2016] [Indexed: 11/22/2022]
Abstract
Horses may become hypoxaemic during anaesthesia despite a high inspired oxygen fraction (FiO2). A lower FiO2 is used commonly in human beings to minimise atelectasis and to improve lung function, and previously has been shown to be of potential benefit in horses in experimental conditions. Other studies suggest no benefit to using a FiO2 of 0.5 during clinically relevant conditions; however, low FiO2 (0.65) is commonly used in practice and in a large number of studies. The present study was performed to compare the effect of a commonly used FiO2 of 0.65 versus 0.90 on calculated respiratory indices in anaesthetised mechanically ventilated horses in a clinical setting. Eighteen healthy Thoroughbred horses anaesthetised for experimental laryngeal surgery were recruited into a prospective, non-blinded, randomised clinical study. Before anaesthesia, the horses were randomly allocated into either low (0.65) or high (0.90) FiO2 groups and arterial blood gas (ABG) analysis was performed every 30 min during anaesthesia to allow for statistical analysis of respiratory indices. As expected, PaO2 was significantly lower in horses anaesthetised with a low FiO2, but was sufficient to fully saturate haemoglobin. There were no significant improvements in any of the other respiratory indices. There is no obvious benefit to be gained from the use of a FiO2 of 0.65 compared to 0.90 for mechanically ventilated Thoroughbred horses anaesthetised in lateral recumbency with isoflurane and a medetomidine constant rate infusion.
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110
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Choe JW, Jung SW, Song JK, Shim E, Choo JY, Kim SY, Hyun JJ, Koo JS, Yim HJ, Lee SW. Predictive Factors of Atelectasis Following Endoscopic Resection. Dig Dis Sci 2016; 61:181-8. [PMID: 26289260 DOI: 10.1007/s10620-015-3844-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/02/2015] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Atelectasis is one of the pulmonary complications associated with anesthesia. Little is known about atelectasis following endoscopic procedures under deep sedation. This study evaluated the frequency, risk factors, and clinical course of atelectasis after endoscopic resection. METHODS A total of 349 patients who underwent endoscopic resection of the upper gastrointestinal tract at a single academic tertiary referral center from March 2010 to October 2013 were enrolled. Baseline characteristics and clinical data were retrospectively reviewed from medical records. To identify atelectasis, we compared the chest radiography taken before and after the endoscopic procedure. RESULTS Among the 349 patients, 68 (19.5 %) had newly developed atelectasis following endoscopic resection. In univariate logistic regression analysis, atelectasis correlated significantly with high body mass index, smoking, diabetes mellitus, procedure duration, size of lesion, and total amount of propofol. In multiple logistic regression analysis, body mass index, procedure duration, and total propofol amount were risk factors for atelectasis following endoscopic procedures. Of the 68 patients with atelectasis, nine patients developed fever, and six patients displayed pneumonic infiltration. The others had no symptoms related to atelectasis. CONCLUSIONS The incidence of radiographic atelectasis following endoscopic resection was nearly 20 %. Obesity, procedural time, and amount of propofol were the significant risk factors for atelectasis following endoscopic procedure. Most cases of the atelectasis resolved spontaneously with no sequelae.
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Affiliation(s)
- Jung Wan Choe
- Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
| | - Sung Woo Jung
- Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea. .,Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan, Gyeonggi-do, 425-707, Korea.
| | - Jong Kyu Song
- Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
| | - Euddeum Shim
- Department of Radiology, Korea University College of Medicine, Ansan, Korea
| | - Ji Yung Choo
- Department of Radiology, Korea University College of Medicine, Ansan, Korea
| | - Seung Young Kim
- Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
| | - Jong Jin Hyun
- Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
| | - Ja Seol Koo
- Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
| | - Hyung Joon Yim
- Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
| | - Sang Woo Lee
- Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
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111
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ETORPHINE-KETAMINE-MEDETOMIDINE TOTAL INTRAVENOUS ANESTHESIA IN WILD IMPALA (AEPYCEROS MELAMPUS) OF 120-MINUTE DURATION. J Zoo Wildl Med 2015; 46:755-66. [PMID: 26667531 DOI: 10.1638/2015-0052.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
There is a growing necessity to perform long-term anesthesia in wildlife, especially antelope. The costs and logistics of transporting wildlife to veterinary practices make surgical intervention a high-stakes operation. Thus there is a need for a field-ready total intravenous anesthesia (TIVA) infusion to maintain anesthesia in antelope. This study explored the feasibility of an etorphine-ketamine-medetomidine TIVA for field anesthesia. Ten wild-caught, adult impala ( Aepyceros melampus ) were enrolled in the study. Impala were immobilized with a standardized combination of etorphine (2 mg) and medetomidine (2.2 mg), which equated to a median (interquartile range [IQR]) etorphine and medetomidine dose of 50.1 (46.2-50.3) and 55.1 (50.8-55.4) μg/kg, respectively. Recumbency was attained in a median (IQR) time of 13.9 (12.0-16.5) min. Respiratory gas tensions, spirometry, and arterial blood gas were analyzed over a 120-min infusion. Once instrumented, the TIVA was infused as follows: etorphine at a variable rate initiated at 40 μg/kg per hour (adjusted according to intermittent deep-pain testing); ketamine and medetomidine at a fixed rate of 1.5 mg/kg per hour and 5 μg/kg per hour, respectively. The etorphine had an erratic titration to clinical effect in four impala. Arterial blood pressure and respiratory and heart rates were all within normal physiological ranges. However, arterial blood gas analysis revealed severe hypoxemia, hypercapnia, and acidosis. Oxygenation and ventilation indices were calculated and highlighted possible co-etiologies to the suspected etorphine-induced respiratory depression as the cause of the blood gas derangements. Impala recovered in the boma post atipamezole (13 mg) and naltrexone (42 mg) antagonism of medetomidine and etorphine, respectively. The etorphine-ketamine-medetomidine TIVA protocol for impala may be sufficient for field procedures of up to 120-min duration. However, hypoxemia and hypercapnia are of paramount concern and thus oxygen supplementation should be considered mandatory. Other TIVA combinations may be superior and warrant further investigation.
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112
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Gilliland S, Brainard J. Postoperative Noninvasive Ventilation Following Cardiothoracic Surgery. Semin Cardiothorac Vasc Anesth 2015; 19:302-8. [DOI: 10.1177/1089253215572699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Postoperative pulmonary complications following cardiac and thoracic surgery are common and associated with significant morbidity and mortality. Noninvasive ventilation has emerged as a successful and well-validated strategy to treat various acute medical conditions. More recently, noninvasive ventilation has been studied in selective surgical patient populations with the goal of preventing postoperative complications and treating acute respiratory failure. In this clinical review, we will briefly examine the incidence of pulmonary complications following cardiothoracic surgery and the physiology and mechanics of acute respiratory failure and noninvasive ventilation. We then present a systematic review of the indications, patient selection, and current literature investigating the specific use of noninvasive ventilation in this population.
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113
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Pathophysiology and Prevention of Intraoperative Atelectasis: A Review of the Literature. J Perianesth Nurs 2015; 30:516-527. [DOI: 10.1016/j.jopan.2014.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 03/17/2014] [Accepted: 03/23/2014] [Indexed: 11/23/2022]
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Diagnostic Imaging of the Lower Respiratory Tract in Neonatal Foals. Vet Clin North Am Equine Pract 2015; 31:497-514. [DOI: 10.1016/j.cveq.2015.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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115
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Salito C, Bovio D, Orsetti G, Salati M, Brunelli A, Aliverti A, Miserocchi G. Effect of lung resection on pleuro-pulmonary mechanics and fluid balance. Respir Physiol Neurobiol 2015; 221:35-40. [PMID: 26555081 DOI: 10.1016/j.resp.2015.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/05/2015] [Accepted: 10/13/2015] [Indexed: 11/28/2022]
Abstract
The aim of the study was to determine in human patients the effect of lung resection on lung compliance and on pleuro-pulmonary fluid balance. Pre and post-operative values of compliance were measured in anesthetized patients undergoing resection for lung cancer (N=11) through double-lumen bronchial intubation. Lung compliance was measured for 10-12 cm H2O increase in alveolar pressure from 5 cm H2O PEEP in control and repeated after resection. No air leak was assessed and pleural fluid was collected during hospital stay. A significant negative correlation (r(2)=0.68) was found between compliance at 10 min and resected mass. Based on the pre-operative estimated lung weight, the decrease in compliance following lung resection exceeded by 10-15% that expected from resected mass. Significant negative relationships were found by relating pleural fluid drainage flow to the remaining lung mass and to post-operative lung compliance. Following lung re-expansion, data suggest a causative relationship between the decrease in compliance and the perturbation in pleuro-pulmonary fluid balance.
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Affiliation(s)
- C Salito
- Dipartimento di Ingegneria Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy.
| | - D Bovio
- Dipartimento di Ingegneria Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - G Orsetti
- Section of Minimally Invasive Thoracic Surgery, Division of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy
| | - M Salati
- Section of Minimally Invasive Thoracic Surgery, Division of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy
| | - A Brunelli
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - A Aliverti
- Dipartimento di Ingegneria Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - G Miserocchi
- Dipartimento di Scienze della Salute, Università degli Studi di Milano-Bicocca, Monza, Italy
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Marashi SM, Hassan Nikkhouei R, Movafegh A, Shoeibi G, Marashi S. Comparison of the Effects of Magnesium Sulfate and Remifentanil on Hemodynamic Responses During Tracheal Extubation After Laparotomy: A Randomized Double-blinded Trial. Anesth Pain Med 2015; 5:e25276. [PMID: 26478862 PMCID: PMC4604289 DOI: 10.5812/aapm.25276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/15/2015] [Accepted: 04/12/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Because blood pressure and heart rate (HR) elevations during tracheal extubation are common, different medications have been studied to prevent such complications. OBJECTIVES To compare magnesium sulfate, remifentanil, and placebo regarding mean arterial pressure (MAP) and HR changes during/after tracheal extubation, in patients who underwent laparotomy. MATERIALS AND METHODS In this randomized double-blinded trial, 120 patients undergoing laparotomy were evenly divided into three groups, including remifentanil (1 mcg/kg), magnesium sulfate (50 mg/kg), or normal saline, as placebo. Hemodynamic responses (MAP and HR) were documented at different times (before operation, during medication administration, immediately before extubation, immediately after extubation, and also 3, 5, and 10 minutes after extubation). The double burst time (DBT) was determined using neuromuscular monitoring, as time interval, between administration of reverse medication and DBT of 100%. RESULTS The HR was significantly lower, immediately after extubation and 3, 5, and 10 minutes after extubation, in both magnesium and remifentanil groups, compared to normal saline (P < 0.001). The MAP was also lower in magnesium and remifentanil groups, immediately after extubation and 3 minutes after extubation, in comparison to the normal saline group (P < 0.001). Mean (± SD) DBT 100% was significantly higher in magnesium group (30.2 ± 15.3) vs. remifenatnil (13.6 ± 6.8) and normal saline (13.5 ± 8.2) groups (P < 0.001). CONCLUSIONS Both remifentanil and magnesium had favorable outcomes in preventing HR and MAP elevation after tracheal extubation. However, remifentanil was associated with more rapid regaining of consciousness and reversal of muscular relaxation.
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Affiliation(s)
- Seyed Mojtaba Marashi
- Anesthesiology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Hassan Nikkhouei
- Anesthesiology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Movafegh
- Anesthesiology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Gita Shoeibi
- Anesthesiology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shaqayeq Marashi
- Anesthesiology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Shaqayeq Marashi, Anesthesiology Department, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-9123257790, Fax: +98-2177568809, E-mail:
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118
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Non-ventilatory approaches to prevent postoperative pulmonary complications. Best Pract Res Clin Anaesthesiol 2015; 29:397-410. [PMID: 26643103 DOI: 10.1016/j.bpa.2015.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/27/2015] [Accepted: 08/28/2015] [Indexed: 02/07/2023]
Abstract
This educational narrative review provides a summary of non-ventilatory strategies to prevent postoperative pulmonary complications (PPCs). It highlights patient- and procedure-related risk factors for PPCs that are non-modifiable, potentially modifiable, or well modifiable. Non-ventilatory strategies, mainly based on the modification of risk factors, play a key role in reducing PPCs. Non-modifiable risk factors, most importantly age, American Society of Anesthesiologists (ASA) class, and risk of the procedure, should be recognized and patients intensively screened for the potential to optimize other, potentially or well-modifiable, risk factors. Potentially modifiable risk factors, mainly comorbidities and the surgical approach, increase the risk of PPCs. Patient-related factors can be improved while procedure-related factors may be adapted in high-risk patients. Well-modifiable risk factors, mainly certain anesthesia techniques, for example, general anesthesia, intravenous opioids or liberal fluid management, and smoking or alcohol abuse, should be avoided as far as possible in order to prevent PPCs.
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Intraoperative mechanical ventilation strategies for one-lung ventilation. Best Pract Res Clin Anaesthesiol 2015; 29:357-69. [DOI: 10.1016/j.bpa.2015.08.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/04/2015] [Accepted: 08/12/2015] [Indexed: 02/05/2023]
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Abstract
PURPOSE OF REVIEW This article reviews the use of noninvasive ventilation (NIV) in patients with acute respiratory failure (ARF), with a critical review of the most recent literature in this setting. RECENT FINDINGS The efficacy of NIV is variable depending on the cause of the episode of ARF. In community-acquired pneumonia, NIV is often associated with poor response, with better response in patients with preexisting cardiac or respiratory disease. In patients with pandemic influenza H1N1 and severe ARF, NIV has been associated with high failure rates but relatively favorable mortality. In acute respiratory distress syndrome, NIV should be used very cautiously and restricted to patients with mild-moderate acute respiratory distress syndrome without shock or metabolic acidosis due to the high failure rate observed in several reports. Despite limited evidence, NIV may improve the outcomes of patients with chest trauma and severe ARF. In postoperative ARF, both continuous positive airway pressure and NIV are effective to improve clinical outcomes, particularly in those with abdominal, cardiac, and thoracic surgery. SUMMARY Although patients with severe hypoxemic ARF are, in general, less likely to be intubated when NIV is used, the efficacy is different among these heterogeneous populations. Therefore, NIV is not routinely recommended in all patients with severe hypoxemic ARF.
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Suzuki S, Eastwood GM, Goodwin MD, Noë GD, Smith PE, Glassford N, Schneider AG, Bellomo R. Atelectasis and mechanical ventilation mode during conservative oxygen therapy: A before-and-after study. J Crit Care 2015; 30:1232-7. [PMID: 26346814 DOI: 10.1016/j.jcrc.2015.07.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/27/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of the study is to assess the effect of a conservative oxygen therapy (COT) (target SpO2 of 90%-92%) on radiological atelectasis and mechanical ventilation modes. MATERIALS AND METHODS We conducted a secondary analysis of 105 intensive care unit patients from a pilot before-and-after study. The primary outcomes of this study were changes in atelectasis score (AS) of 555 chest radiographs assessed by radiologists blinded to treatment allocation and time to weaning from mandatory ventilation and first spontaneous ventilation trial (SVT). RESULTS There was a significant difference in overall AS between groups, and COT was associated with lower time-weighted average AS. In addition, in COT patients, change from mandatory to spontaneous ventilation or time to first SVT was shortened. After adjustment for baseline characteristics and interactions between oxygen therapy, radiological atelectasis, and mechanical ventilation management, patients in the COT group had significantly lower "best" AS (adjusted odds ratio, 0.28 [95% confidence interval {CI}, 0.12-0.66]; P=.003) and greater improvement in AS in the first 7 days (adjusted odds ratio, 0.42 [95% CI, 0.17-0.99]; P=.049). Moreover, COT was associated with significantly earlier successful weaning from a mandatory ventilation mode (adjusted hazard ratio, 2.96 [95% CI, 1.73-5.04]; P<.001) and with shorter time to first SVT (adjusted hazard ratio, 1.77 [95% CI, 1.13-2.78]; P=.013). CONCLUSIONS In mechanically ventilated intensive care unit patients, COT might be associated with decreased radiological evidence of atelectasis, earlier weaning from mandatory ventilation modes, and earlier first trial of spontaneous ventilation.
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Affiliation(s)
- Satoshi Suzuki
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne VIC, Australia
| | - Glenn M Eastwood
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne VIC, Australia
| | - Mark D Goodwin
- Department of Radiology, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Geertje D Noë
- Department of Radiology, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Paul E Smith
- Department of Radiology, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Neil Glassford
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne VIC, Australia
| | - Antoine G Schneider
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne VIC, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Melbourne, VIC, Australia.
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Schliewert EC, Lascola KM, O'Brien RT, Clark-Price SC, Wilkins PA, Foreman JH, Mitchell MA, Hartman SK, Kline KH. Comparison of radiographic and computed tomographic images of the lungs in healthy neonatal foals. Am J Vet Res 2015; 76:42-52. [PMID: 25535660 DOI: 10.2460/ajvr.76.1.42] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare CT and radiographic images of the lungs in sedated healthy foals positioned in sternal recumbency and to investigate whether a relationship exists between CT-derived measurements of lung attenuation and Paco2 and Pao2. ANIMALS 6 healthy Standardbred foals < 14 days of age. PROCEDURES Thoracic CT images were acquired followed by radiographic views with each foal sedated and positioned in sternal recumbency. For each foal, both CT and radiographic images were evaluated for severity and extent of changes by lung regions on the basis of a subjective scoring system by 3 investigators. Quantitative analysis of CT images was also performed. Assessments of Pao2 and Paco2 were performed before sedation, following sedation prior to CT, and after CT prior to radiography. RESULTS Interobserver agreement for CT and radiographic image scoring was strong (0.73) and fair (0.65), respectively; intraobserver agreement was near perfect for CT (0.97) and radiographic (0.94) image scoring. Increased CT attenuation and radiographic changes were identified for all foals and were preferentially distributed in the caudoventral portion of the lungs. Radiographic scores were significantly lower than CT image scores. A positive correlation (r = 0.872) between lung attenuation and CT image score was identified. A significant increase in Paco2 was not considered clinically relevant. Significant changes in Pao2 were not observed. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that interpretation of CT images may be less subjective, compared with interpretation of radiographic images. These findings may aid in the evaluation of CT and radiographic images of neonatal foals with respiratory tract disease.
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Affiliation(s)
- Eva-Christina Schliewert
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL 61802
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Ferrando C, Soro M, Canet J, Unzueta MC, Suárez F, Librero J, Peiró S, Llombart A, Delgado C, León I, Rovira L, Ramasco F, Granell M, Aldecoa C, Diaz O, Balust J, Garutti I, de la Matta M, Pensado A, Gonzalez R, Durán ME, Gallego L, Del Valle SG, Redondo FJ, Diaz P, Pestaña D, Rodríguez A, Aguirre J, García JM, García J, Espinosa E, Charco P, Navarro J, Rodríguez C, Tusman G, Belda FJ. Rationale and study design for an individualized perioperative open lung ventilatory strategy (iPROVE): study protocol for a randomized controlled trial. Trials 2015; 16:193. [PMID: 25927183 PMCID: PMC4425893 DOI: 10.1186/s13063-015-0694-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 03/30/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Postoperative pulmonary and non-pulmonary complications are common problems that increase morbidity and mortality in surgical patients, even though the incidence has decreased with the increased use of protective lung ventilation strategies. Previous trials have focused on standard strategies in the intraoperative or postoperative period, but without personalizing these strategies to suit the needs of each individual patient and without considering both these periods as a global perioperative lung-protective approach. The trial presented here aims at comparing postoperative complications when using an individualized ventilatory management strategy in the intraoperative and immediate postoperative periods with those when using a standard protective ventilation strategy in patients scheduled for major abdominal surgery. METHODS This is a comparative, prospective, multicenter, randomized, and controlled, four-arm trial that will include 1012 patients with an intermediate or high risk for postoperative pulmonary complications. The patients will be divided into four groups: (1) individualized perioperative group: intra- and postoperative individualized strategy; (2) intraoperative individualized strategy + postoperative continuous positive airway pressure (CPAP); (3) intraoperative standard ventilation + postoperative CPAP; (4) intra- and postoperative standard strategy (conventional strategy). The primary outcome is a composite analysis of postoperative complications. DISCUSSION The Individualized Perioperative Open-lung Ventilatory Strategy (iPROVE) is the first multicenter, randomized, and controlled trial to investigate whether an individualized perioperative approach prevents postoperative pulmonary complications. TRIAL REGISTRATION Registered on 5 June 2014 with identification no. NCT02158923 .
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Affiliation(s)
- Carlos Ferrando
- Anesthesiology and Critical Care Department, Hospital Clínico of Valencia, Av. Blasco Ibañez, 17, Valencia, CP: 46010, Spain.
| | - Marina Soro
- Anesthesiology and Critical Care Department, Hospital Clínico of Valencia, Av. Blasco Ibañez, 17, Valencia, CP: 46010, Spain.
| | - Jaume Canet
- Anesthesiology and Critical Care Department, Hospital Germans Tries i Pujol, Carretera de Canyet s/n, 08916, Badalona, Spain.
| | - Ma Carmen Unzueta
- Anesthesiology and Critical Care Department, Hospital San Pau, Carrer de Sant Quintí, 89, CP: 08026, Barcelona, Spain.
| | - Fernando Suárez
- Intensive Care Department, Uppsala University Hospital, Suecia Akademiska Sjukhuset Uppsala University, CP: 75185, Uppsala, Sweden.
| | - Julián Librero
- FISABIO salud Pública, Av. Cataluña, 21, CP: 46020, Valencia, Spain.
| | - Salvador Peiró
- FISABIO salud Pública, Av. Cataluña, 21, CP: 46020, Valencia, Spain.
| | - Alicia Llombart
- Anesthesiology and Critical Care Department, Hospital Clínico of Valencia, Av. Blasco Ibañez, 17, Valencia, CP: 46010, Spain.
| | - Carlos Delgado
- Anesthesiology and Critical Care Department, Hospital Clínico of Valencia, Av. Blasco Ibañez, 17, Valencia, CP: 46010, Spain.
| | - Irene León
- Anesthesiology and Critical Care Department, Hospital Clínico of Valencia, Av. Blasco Ibañez, 17, Valencia, CP: 46010, Spain.
| | - Lucas Rovira
- Anesthesiology and Critical Care Department, Hospital de Manises, Av. De la Generalitat Valenciana, Manises, CP: 46940, Spain.
| | - Fernando Ramasco
- Anesthesiology and Critical Care Department, Hospital La Princesa of Madrid, Calle de Diego León, 62, CP: 28006, Madrid, Spain.
| | - Manuel Granell
- Anesthesiology and Critical Care Department, Hospital General of Valencia, Av. De les Tres Creus, 2, Valencia, CP: 46014, Spain.
| | - César Aldecoa
- Anesthesiology and Critical Care Department, Hospital Río Hortega of Valladolid, Calle Dulzaina, 2, Valladolid, CP 47012, Spain.
| | - Oscar Diaz
- Anesthesiology and Critical Care Department, Hospital La Fe of Valencia, Av. De Fernando Abril Martorell, 106, Valencia, CP: 46026, Spain.
| | - Jaume Balust
- Anesthesiology and Critical Care Department, Hospital Clínic i Provincial of Barcelona, Carrer Villarroel 170, Barcelona, CP: 08036, Spain.
| | - Ignacio Garutti
- Anesthesiology and Critical Care Department, Hospital General Gregorio Marañon of Madrid, Calle del Doctor Esquerdo, 46, Madrid, CP: 28007, Spain.
| | - Manuel de la Matta
- Anesthesiology and Critical Care Department, Hospital Vírgen del Rocio of Sevilla, Av. Manuel Siurot s/n, Sevilla, CP: 41013, Spain.
| | - Alberto Pensado
- Anesthesiology and Critical Care Department, Complejo Hospitalario Juan Canalejo of La Coruña, Xubias, 84, La Coruña, CP: 15006, Spain.
| | - Rafael Gonzalez
- Anesthesiology and Critical Care Department, Hospital of León, C/ Altos de Nava s/n, Leon, CP: 24701, Spain.
| | - M Eugenia Durán
- Anesthesiology and Critical Care Department, Hospital Vírgen de la Arraixaca of Murcia, Carretera de Madrid-Cartagena s/n, Madrird, CP: 30120, Spain.
| | - Lucia Gallego
- Anesthesiology and Critical Care Department, Hospital Miguel Servet of Zaragoza, Paseo Isabel la Católica, 1-3, Zaragoza, CP: 50009, Spain.
| | - Santiago García Del Valle
- Anesthesiology and Critical Care Department, Hospital Fundación of Alcorcón, Calle de Valdelaguna, 1, Alcorcón, CP: 28922, Spain.
| | - Francisco J Redondo
- Anesthesiology and Critical Care Department, Hospital General of Ciudad Real, C/ Alisos, 19, Ciudad Real, CP: 13002, Spain.
| | - Pedro Diaz
- Anesthesiology and Critical Care Department, Hospital de Valme of Sevilla, Av. Bellavista s/n, Sevilla, CP: 41014, Spain.
| | - David Pestaña
- Anesthesiology and Critical Care Department, Hospital Ramón y Cajal of Madrid, Carretera de Colmenar Viejo Km 9, Madrid, CP: 28034, Spain.
| | - Aurelio Rodríguez
- Anesthesiology and Critical Care Department, Hospital de Gran Canaria Dr. Negrín, c/ Barranco de la Ballena s/n, Negrin, CP: 35010, Spain.
| | - Javier Aguirre
- Anesthesiology and Critical Care Department, Hospital of Galdakano, Barrio Labeaga s/n, Galdakano, CP: 48960, Spain.
| | - Jose M García
- Anesthesiology and Critical Care Department, Complejo Hospitalario Juan Ramón Jimenez of Huelva, Ronda exterior norte, s/n, Huelva, CP: 21005, Spain.
| | - Javier García
- Anesthesiology and Critical Care Department, Hospital Puerta de Hierro of Majadahonda, C/ Manuel de Falla, 1, Majadahonda, CP: 28222, Spain.
| | - Elena Espinosa
- Anesthesiology and Critical Care Department, Hospital Nuestra Señora de la Candelaria of Santa Cruz de Tenerife, Carretera del Rosario, 145, Santa Cruz de Tenerife, CP: 38010, Spain.
| | - Pedro Charco
- Anesthesiology and Critical Care Department, Hospital Son Espases of Mallorca, Carretera de la Valldemosa, 79, Mallorca, CP: 07120, Spain.
| | - Jose Navarro
- Anesthesiology and Critical Care Department, Hospital General of Alicante, Pintor Baeza, 12, Alicante, CP: 03010, Spain.
| | - Clara Rodríguez
- FISABIO salud Pública, Av. Cataluña, 21, CP: 46020, Valencia, Spain.
| | - Gerardo Tusman
- Anesthesiology Department, Hospital Privado de Comunidad Mar de Plata, Mar de Plata, Argentina.
| | - Francisco Javier Belda
- Anesthesiology and Critical Care Department, Hospital Clínico of Valencia, Av. Blasco Ibañez, 17, Valencia, CP: 46010, Spain.
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Lung recruitment manoeuvres do not cause haemodynamic instability or oxidative stress but improve oxygenation and lung mechanics in a newborn animal model: an observational study. Eur J Anaesthesiol 2015; 31:457-65. [PMID: 24979585 DOI: 10.1097/eja.0000000000000108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lung recruitment manoeuvres in neonates during anaesthesia are not performed routinely due to concerns about causing barotrauma, haemodynamic instability and oxidative stress. OBJECTIVE To assess the influence of recruitment manoeuvres and positive end-expiratory pressure (PEEP) on haemodynamics, oxidative stress, oxygenation and lung mechanics. DESIGN A prospective experimental study. SETTING Experimental Unit, La Paz University Hospital, Madrid, Spain. ANIMALS Eight newborn piglets (<48 h) with healthy lungs under general anaesthesia. INTERVENTIONS The recruitment manoeuvres in pressure-controlled ventilation (PCV) were performed along with a constant driving pressure of 15 cmH2O. After the recruitment manoeuvres, PEEP was reduced in a stepwise fashion to find the maximal dynamic compliance step (maxCDyn-PEEP). Blood oxidative stress biomarkers (lipid peroxidation products, protein carbonyls, total glutathione, oxidised glutathione, reduced glutathione and activity of glutathione peroxidase) were analysed. MAIN OUTCOME MEASURES Haemodynamic parameters, arterial partial pressure of oxygen (paO2), tidal volume (Vt), dynamic compliance (Cdyn) and oxidative stress biomarkers were measured. RESULTS The recruitment manoeuvres did not induce barotrauma. Haemodynamic instability was not detected either in the maximum pressure step (overdistension step 5) or during the entire process. No substantial differences were observed in blood oxidative stress parameters analysed as compared with their baseline values (with 0 PEEP) or the values obtained 180 min after the onset of the recruitment manoeuvres (optimal PEEP). Significant maximal values were achieved in step 14 with an increase in paO2 (32.43 ± 8.48 vs. 40.39 ± 15.66 kPa; P = 0.037), Vt (47.75 ± 13.59 vs. 73.87 ± 13.56 ml; P = 0.006) and Cdyn (2.50 ± 0.64 vs. 4.75 ± 0.88 ml cmH2O; P < 0.001). Maximal dynamic compliance step (maxCdyn-PEEP) was 2 cmH2O. CONCLUSION Recruitment manoeuvres in PCV with a constant driving pressure are a well tolerated open-lung strategy in a healthy-lung neonatal animal model under general anaesthesia. The recruitment manoeuvres improve oxygenation parameters and lung mechanics and do not cause barotrauma, haemodynamic instability or oxidative stress.
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Ezri T, Evron S, Petrov I, Schachter P, Berlovitz Y, Shimonov M. Residual Curarization and Postoperative Respiratory Complications Following Laparoscopic Sleeve Gastrectomy. The Effect of Reversal Agents: Sugammadex vs. Neostigmine. J Crit Care Med (Targu Mures) 2015; 1:61-67. [PMID: 29967817 PMCID: PMC5953289 DOI: 10.1515/jccm-2015-0009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/20/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Incomplete muscle relaxant reversal or re-curarization may be associated with postoperative respiratory complications. In this retrospective study we compared the incidence of postoperative residual curarization and respiratory complications in association with the type of muscle relaxant reversal agent, sugammadex or neostigmine, in patients undergoing laparoscopic sleeve gastrectomy. MATERIAL AND METHODS We reviewed the charts of all patients (179) undergoing laparoscopic sleeve gastrectomy from July 2012 to July 2013 at Wolfson Medical Center. Sugammadex 1.5-2 mg/kg (112 patients) or neostigmine 2.5 mg (67 patients) were used as reversal agents. Results were compared by the type of reversal agent employed. Compared parameters included demographic and anaesthetic data, residual curarization, oxyhemoglobin saturation (SpO2) in the recovery room (PACU), episodes of SpO2 lower than 90% in PACU, unexpected intensive care (ICU) admissions, incidence of atelectasis and pneumonia, re-intubation and duration of hospitalization. RESULTS Obstructive sleep apnea syndrome (OSAS) was more frequent in the sugammadex group (19% vs. 8%; p = 0.026). Total intravenous anesthesia (TIVA) was more frequently associated with sugammadex (33% vs. 16%; p = 0.007). There were no differences in postoperative residual curarization, SpO2 < 90% episodes, reintubation, ICU admissions, pulmonary complications and duration of hospitalization. CONCLUSION With the inherent limitations of a retrospective study, the use of sugammadex following laparoscopic sleeve gastrectomy showed no advantage over neostigmine in terms of residual curarization and respiratory complications.
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Affiliation(s)
- Tiberiu Ezri
- The Departments of Anesthesia, The Edith Wolfson Medical Center, Holon, Israel
- The Departments of Outcomes Research Consortium, Holon, Israel
| | - Shmuel Evron
- The Departments of Anesthesia, The Edith Wolfson Medical Center, Holon, Israel
- The Departments of Outcomes Research Consortium, Holon, Israel
| | - Irina Petrov
- The Departments of Anesthesia, The Edith Wolfson Medical Center, Holon, Israel
| | - Pinhas Schachter
- The Departments of Surgery, The Edith Wolfson Medical Center, Holon, Israel
| | - Yitzhak Berlovitz
- The Departments of Management, The Edith Wolfson Medical Center, Holon, Israel
| | - Mordechai Shimonov
- The Departments of Surgery, The Edith Wolfson Medical Center, Holon, Israel
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Taylor A, DeBoard Z, Gauvin JM. Prevention of Postoperative Pulmonary Complications. Surg Clin North Am 2015; 95:237-54. [DOI: 10.1016/j.suc.2014.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Das A, Cole O, Chikhani M, Wang W, Ali T, Haque M, Bates DG, Hardman JG. Evaluation of lung recruitment maneuvers in acute respiratory distress syndrome using computer simulation. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:8. [PMID: 25578295 PMCID: PMC4329196 DOI: 10.1186/s13054-014-0723-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 12/16/2014] [Indexed: 02/03/2023]
Abstract
Introduction Direct comparison of the relative efficacy of different recruitment maneuvers (RMs) for patients with acute respiratory distress syndrome (ARDS) via clinical trials is difficult, due to the heterogeneity of patient populations and disease states, as well as a variety of practical issues. There is also significant uncertainty regarding the minimum values of positive end-expiratory pressure (PEEP) required to ensure maintenance of effective lung recruitment using RMs. We used patient-specific computational simulation to analyze how three different RMs act to improve physiological responses, and investigate how different levels of PEEP contribute to maintaining effective lung recruitment. Methods We conducted experiments on five ‘virtual’ ARDS patients using a computational simulator that reproduces static and dynamic features of a multivariable clinical dataset on the responses of individual ARDS patients to a range of ventilator inputs. Three recruitment maneuvers (sustained inflation (SI), maximal recruitment strategy (MRS) followed by a titrated PEEP, and prolonged recruitment maneuver (PRM)) were implemented and evaluated for a range of different pressure settings. Results All maneuvers demonstrated improvements in gas exchange, but the extent and duration of improvement varied significantly, as did the observed mechanism of operation. Maintaining adequate post-RM levels of PEEP was seen to be crucial in avoiding cliff-edge type re-collapse of alveolar units for all maneuvers. For all five patients, the MRS exhibited the most prolonged improvement in oxygenation, and we found that a PEEP setting of 35 cm H2O with a fixed driving pressure of 15 cm H2O (above PEEP) was sufficient to achieve 95% recruitment. Subsequently, we found that PEEP titrated to a value of 16 cm H2O was able to maintain 95% recruitment in all five patients. Conclusions There appears to be significant scope for reducing the peak levels of PEEP originally specified in the MRS and hence to avoid exposing the lung to unnecessarily high pressures. More generally, our study highlights the huge potential of computer simulation to assist in evaluating the efficacy of different recruitment maneuvers, in understanding their modes of operation, in optimizing RMs for individual patients, and in supporting clinicians in the rational design of improved treatment strategies. Electronic supplementary material The online version of this article (doi:10.1186/s13054-014-0723-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anup Das
- School of Engineering, University of Warwick, Library Road, Coventry, CV4 7AL, UK.
| | - Oana Cole
- Anaesthesia & Critical Care Research Group, University of Nottingham, Derby Road, Nottingham, NG7 2UH, UK.
| | - Marc Chikhani
- Anaesthesia & Critical Care Research Group, University of Nottingham, Derby Road, Nottingham, NG7 2UH, UK.
| | - Wenfei Wang
- School of Engineering, University of Warwick, Library Road, Coventry, CV4 7AL, UK.
| | - Tayyba Ali
- Anaesthesia & Critical Care Research Group, University of Nottingham, Derby Road, Nottingham, NG7 2UH, UK.
| | - Mainul Haque
- Anaesthesia & Critical Care Research Group, University of Nottingham, Derby Road, Nottingham, NG7 2UH, UK.
| | - Declan G Bates
- School of Engineering, University of Warwick, Library Road, Coventry, CV4 7AL, UK.
| | - Jonathan G Hardman
- Anaesthesia & Critical Care Research Group, University of Nottingham, Derby Road, Nottingham, NG7 2UH, UK.
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Habre W, Peták F. Perioperative use of oxygen: variabilities across age. Br J Anaesth 2014; 113 Suppl 2:ii26-36. [DOI: 10.1093/bja/aeu380] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Abstract
Hip fracture is one of the most common orthopedic conditions associated with significant morbidity and mortality. Patients with hip fracture are usually older, with significant comorbidities. Delayed surgical treatment beyond 48 hours after admission is associated with significantly higher mortality. Hereby clinicians are presented with the challenge to optimize the complex hip fracture within a short time period. This article reviews the evidence regarding preoperative, intraoperative, and postoperative considerations, and provides insights into the best strategies with which to optimize the patient's condition and improve perioperative outcomes.
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Affiliation(s)
- Jiabin Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Jaimo Ahn
- Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nabil M Elkassabany
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Haw A, Hofmeyr M, Fuller A, Buss P, Miller M, Fleming G, Meyer L. Butorphanol with oxygen insufflation corrects etorphine-induced hypoxaemia in chemically immobilized white rhinoceros (Ceratotherium simum). BMC Vet Res 2014; 10:253. [PMID: 25315767 PMCID: PMC4205281 DOI: 10.1186/s12917-014-0253-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 10/09/2014] [Indexed: 11/10/2022] Open
Abstract
Background Opioid-induced immobilization is associated with severe respiratory depression in the white rhinoceros. We evaluated the efficacy of butorphanol and oxygen insufflation in alleviating opioid-induced respiratory depression in eight boma-managed rhinoceros. Results Chemical immobilization with etorphine, azaperone and hyaluronidase, as per standard procedure for the white rhinoceros, caused severe respiratory depression with hypoxaemia (PaO2 = 27 ± 7 mmHg [mean ± SD]), hypercapnia (PaCO2 = 82 ± 6 mmHg) and acidosis (pH =7.26 ± 0.02) in the control trial at 5 min. Compared to pre-intervention values, butorphanol administration (without oxygen) improved the PaO2 (60 ± 3 mmHg, F(3,21) =151.9, p <0.001), PaCO2 (67 ± 4 mmHg, F(3,21) =22.57, p <0.001) and pH (7.31 ± 0.06, F(3,21) =27.60, p <0.001), while oxygen insufflation alone exacerbated the hypercapnia (123 ± 20 mmHg, F(3,21) =50.13, p <0.001) and acidosis (7.12 ± 0.07, F(3,21) =110.6, p <0.001). Surprisingly, butorphanol combined with oxygen fully corrected the opioid-induced hypoxaemia (PaO2 = 155 ± 53 mmHg) and reduced the hypercapnia over the whole immobilization period (p <0.05, areas under the curves) compared to the control trial. However, this intervention (butorphanol + oxygen) did not have any effect on the arterial pH. Conclusions Oxygen insufflation combined with a single intravenous dose of butorphanol improved the immobilization quality of boma-managed white rhinoceros by correcting the opioid-induced hypoxaemia, but did not completely reverse all components of respiratory depression. The efficacy of this intervention in reducing respiratory depression in field-captured animals remains to be determined.
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Ray K, Bodenham A, Paramasivam E. Pulmonary atelectasis in anaesthesia and critical care. ACTA ACUST UNITED AC 2014. [DOI: 10.1093/bjaceaccp/mkt064] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Images in Anesthesiology: Severe Unilateral Atelectasis during Induction of Anesthesia. Anesthesiology 2014; 121:876. [DOI: 10.1097/aln.0b013e31829f02a0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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133
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Lopes PF, Nunes N, Belmonte E, Almeida RM, Dias L, Pereira Neto G, Souza A. Two levels of the inspired oxygen fraction in propofol-anesthetized dogs with high intracranial pressure: cardiopulmonary function. ARQ BRAS MED VET ZOO 2014. [DOI: 10.1590/1678-6519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In the initial stage of traumatic brain injury, the use of 1.0 inspired oxygen fraction (FiO2) is indicated. However, high FiO2 has been correlated with atelectasis. Thus, the effects of FiO2= 1.0 and FiO2= 0.6 on the cardiopulmonary function in propofol-anesthetized dogs with high intracranial pressure (ICP) were evaluated. Eight dogs were anesthetized on two occasions, receiving, during controlled ventilation, an FiO2= 1 (G100) or an FiO2= 0.6 (G60). Propofol was used for induction (10mg.kg-1) followed by a continuous rate infusion (0.6mg.kg-1.minute-1). An increase in the ICP was induced by temporary obliteration of the right jugular vein (OJv) 50 minutes after induction of anesthesia. The measurement was taken twenty minutes after OJv (T0) and then at 15-minute intervals (T15 to T60). Alveolar oxygen partial pressure in G60 was lower than in G100 during the whole procedure. Alveolar-arterial oxygen gradient in G100 was greater than in G60 at T0 and at T60. No differences were observed for arterial oxygen partial pressure/inspired oxygen fraction ratio, arterial-to-alveolar oxygen pressure ratio, respiratory index, venous admixture, oxygen delivery, oxygen consumption, oxygen extraction, heart rate, mean pulmonary arterial pressure, pulmonary arterial occlusion pressure, cardiac index, stroke index and systemic vascular resistance index. In G100, mean arterial pressure at T0 was higher than at T45. In dogs with high ICP, the cardiopulmonary function was not influenced by the different FiO2 used.
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Grychtol B, Elke G, Meybohm P, Weiler N, Frerichs I, Adler A. Functional validation and comparison framework for EIT lung imaging. PLoS One 2014; 9:e103045. [PMID: 25110887 PMCID: PMC4128601 DOI: 10.1371/journal.pone.0103045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 06/26/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Electrical impedance tomography (EIT) is an emerging clinical tool for monitoring ventilation distribution in mechanically ventilated patients, for which many image reconstruction algorithms have been suggested. We propose an experimental framework to assess such algorithms with respect to their ability to correctly represent well-defined physiological changes. We defined a set of clinically relevant ventilation conditions and induced them experimentally in 8 pigs by controlling three ventilator settings (tidal volume, positive end-expiratory pressure and the fraction of inspired oxygen). In this way, large and discrete shifts in global and regional lung air content were elicited. METHODS We use the framework to compare twelve 2D EIT reconstruction algorithms, including backprojection (the original and still most frequently used algorithm), GREIT (a more recent consensus algorithm for lung imaging), truncated singular value decomposition (TSVD), several variants of the one-step Gauss-Newton approach and two iterative algorithms. We consider the effects of using a 3D finite element model, assuming non-uniform background conductivity, noise modeling, reconstructing for electrode movement, total variation (TV) reconstruction, robust error norms, smoothing priors, and using difference vs. normalized difference data. RESULTS AND CONCLUSIONS Our results indicate that, while variation in appearance of images reconstructed from the same data is not negligible, clinically relevant parameters do not vary considerably among the advanced algorithms. Among the analysed algorithms, several advanced algorithms perform well, while some others are significantly worse. Given its vintage and ad-hoc formulation backprojection works surprisingly well, supporting the validity of previous studies in lung EIT.
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Affiliation(s)
- Bartłomiej Grychtol
- Department of Medical Physics in Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
- Fraunhofer Project Group for Automation in Medicine and Biotechnology, Mannheim, Germany
| | - Gunnar Elke
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - Patrick Meybohm
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Norbert Weiler
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - Inéz Frerichs
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - Andy Adler
- Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
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Schauvliege S, Savvas I, Gasthuys F. The effect of the inspired oxygen fraction on arterial blood oxygenation in spontaneously breathing, isoflurane anaesthetized horses: a retrospective study. Vet Anaesth Analg 2014; 42:280-5. [PMID: 25039320 DOI: 10.1111/vaa.12208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/12/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the influence of two inspired oxygen fractions (FiO(2)) on the arterial oxygenation in horses anaesthetized with isoflurane. STUDY DESIGN Retrospective, case-control clinical study. ANIMALS Two hundred equine patients undergoing non-abdominal surgery (ASA class 1-2), using a standardized anaesthetic protocol and selected from anaesthetic records of a period of three years, based on pre-defined inclusion criteria. METHODS In group O (n = 100), medical oxygen acted as carrier gas, while in group M (n = 100), a medical mixture of oxygen and air (FiO(2) 0.60) was used. Demographic data, FiO(2), arterial oxygen tension (PaO(2)) and routinely monitored physiologic data were recorded. The alveolar-arterial oxygen tension difference [P(A-a)O(2)] and PaO(2)/FiO(2) ratio were calculated. The area under the curve, standardized to the anaesthetic duration, was calculated and statistically compared between groups using t-tests or Mann-Whitney tests as appropriate. Categorical data were compared using Chi-square tests. RESULTS No significant differences in age, body weight, sex, breed, surgical procedure, position, anaesthetic duration or arterial carbon dioxide tension were found. Mean FiO(2) was 0.78 in group O and 0.60 in group M. Compared to group O, significantly lower values for PaO(2) and for P(A-a)O(2) were found in group M. In contrast, the PaO(2)/FiO(2) ratio and the percentage of horses with a PaO(2) <100 mmHg (13.33 kPa) were comparable in both groups. CONCLUSIONS Although a reduction of the inspired oxygen fraction resulted in a lower PaO(2), the P(A-a)O(2) was also lower and the number of horses with PaO(2) values <100 mmHg was comparable. CLINICAL RELEVANCE In healthy isoflurane anaesthetized horses, the use of a mixture of oxygen and air as carrier gas seems acceptable, but further, prospective studies are needed to confirm whether it results in a lower degree of ventilation/perfusion mismatching.
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Affiliation(s)
- Stijn Schauvliege
- Department of Surgery and Anaesthesia of Domestic Animals, Faculty of Veterinary Medicine, University of Gent, Merelbeke, Belgium
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Downs JB, Robinson LA, Steighner ML, Thrush D, Reich RR, Räsänen JO. "Open lung ventilation optimizes pulmonary function during lung surgery". J Surg Res 2014; 192:242-9. [PMID: 25033701 DOI: 10.1016/j.jss.2014.06.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 06/07/2014] [Accepted: 06/17/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND We evaluated an "open lung" ventilation (OV) strategy using low tidal volumes, low respiratory rate, low FiO2, and high continuous positive airway pressure in patients undergoing major lung resections. MATERIALS AND METHODS In this phase I pilot study, twelve consecutive patients were anesthetized using conventional ventilator settings (CV) and then OV strategy during which oxygenation and lung compliance were noted. Subsequently, a lung resection was performed. Data were collected during both modes of ventilation in each patient, with each patient acting as his own control. The postoperative course was monitored for complications. RESULTS Twelve patients underwent open thoracotomies for seven lobectomies and five segmentectomies. The OV strategy provided consistent one-lung anesthesia and improved static compliance (40 ± 7 versus 25 ± 4 mL/cm H2O, P = 0.002) with airway pressures similar to CV. Postresection oxygenation (SpO2/FiO2) was better during OV (433 ± 11 versus 386 ± 15, P = 0.008). All postoperative chest x-rays were free of atelectasis or infiltrates. No patient required supplemental oxygen at any time postoperatively or on discharge. The mean hospital stay was 4 ± 1 d. There were no complications or mortality. CONCLUSIONS The OV strategy, previously shown to have benefits during mechanical ventilation of patients with respiratory failure, proved safe and effective in lung resection patients. Because postoperative pulmonary complications may be directly attributable to the anesthetic management, adopting an OV strategy that optimizes lung mechanics and gas exchange may help reduce postoperative problems and improve overall surgical results. A randomized trial is planned to ascertain whether this technique will reduce postoperative pulmonary complications.
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Affiliation(s)
- John B Downs
- Department of Anesthesiology, Moffitt Cancer Center, Tampa, Florida
| | - Lary A Robinson
- Department of Thoracic Oncology (Surgery), Moffitt Cancer Center, Tampa, Florida.
| | | | - David Thrush
- Department of Anesthesiology, Moffitt Cancer Center, Tampa, Florida
| | - Richard R Reich
- College of Arts and Sciences, University of South Florida Sarasota-Manatee, Florida; Department of Biostatistics, Moffitt Cancer Center, Tampa, Florida
| | - Jukka O Räsänen
- Department of Anesthesiology, Moffitt Cancer Center, Tampa, Florida
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Ela Y, Bakı ED, Ateş M, Kokulu S, Keleş İ, Karalar M, Şenay H, Sıvacı RG. Exploring for the safer ventilation method in laparoscopic urologic patients? Conventional or low tidal? J Laparoendosc Adv Surg Tech A 2014; 24:786-90. [PMID: 24918629 DOI: 10.1089/lap.2014.0004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To study the effects of low tidal volume with positive end-expiratory pressure (PEEP) on arterial blood gases of patients undergoing laparoscopic urologic surgeries. SUBJECTS AND METHODS Eighty-six laparoscopic urologic patients were enrolled in this study. Patients were randomized into two groups according to the ventilatory settings. In the conventional group (Group C) (n=43), the tidal volume was 10 mL/kg, and the PEEP was set at 0 cm of H2O. In the low tidal volume with PEEP group (Group LP), the tidal volume was 6 mL/kg, with PEEP of 5 cm of H2O. In both groups total minute volume was 6 L/kg. Peak and plateau airway pressure (PPEAK and PPLAT, respectively) and arterial blood gases were recorded before pneumoperitoneum (PNP) (T1) and the first and third hour (T3) after PNP induction and also after extubation in the intensive care unit. Additionally, heart rate, mean arterial pressure, and peripheral O2 saturation of hemoglobin were recorded. RESULTS Heart rate, PPEAK, and PPLAT values were similar in both groups. Partial arterial O2 pressure values measured postoperatively were significantly higher in Group LP, whereas those measured before PNP induction were similar (P=.014 and P=.056, respectively). Compared with the baseline, partial arterial CO2 pressure values measured at T1 and at T3 after PNP induction were significantly higher in Group C than in Group LP (P<.001). The pH values of Group C at T1 and at T3 postoperatively were significantly lower than the values of Group LP (P<.001). Extubation times were significantly lower in Group LP. CONCLUSIONS The results of the present study suggest that low tidal volume with PEEP application may be a good alternative for preventing high CO2 levels and yielding better oxygenation and lower extubation times in patients undergoing prolonged laparoscopic urology.
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Affiliation(s)
- Yüksel Ela
- 1 Department of Anesthesiology and Reanimation, Afyon Kocatepe University , Afyon, Turkey
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Lascola KM, O'Brien RT, Wilkins PA, Clark-Price SC, Hartman SK, Mitchell MA. Qualitative and quantitative interpretation of computed tomography of the lungs in healthy neonatal foals. Am J Vet Res 2014; 74:1239-46. [PMID: 23977897 DOI: 10.2460/ajvr.74.9.1239] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To qualitatively describe lung CT images obtained from sedated healthy equine neonates (≤ 14 days of age), use quantitative analysis of CT images to characterize attenuation and distribution of gas and tissue volumes within the lungs, and identify differences between lung characteristics of foals ≤ 7 days of age and foals > 7 days of age. ANIMALS 10 Standardbred foals between 2.5 and 13 days of age. PROCEDURES Foals were sedated with butorphanol, midazolam, and propofol and positioned in sternal recumbency for thoracic CT. Image analysis software was used to exclude lung from nonlung structures. Lung attenuation was measured in Hounsfield units (HU) for analysis of whole lung and regional changes in attenuation and lung gas and tissue components. Degree of lung attenuation was classified as follows: hyperinflated or emphysema, -1,000 to -901 HU; well aerated, -900 to -501 HU; poorly aerated, -500 to -101 HU; and nonaerated, > -100 HU. RESULTS Qualitative evidence of an increase in lung attenuation and patchy alveolar patterns in the ventral lung region were more pronounced in foals ≤ 7 days of age than in older foals. Quantitative analysis revealed that mean ± SD lung attenuation was greater in foals ≤ 7 days of age (-442 ± 28 HU) than in foals > 7 days of age (-521 ± 24 HU). Lung aeration and gas volumes were lower than in other regions ventrally and in the mid lung region caudal to the heart. CONCLUSIONS AND CLINICAL RELEVANCE-Identified radiographic patterns and changes in attenuation were most consistent with atelectasis and appeared more severe in foals ≤ 7 days of age than in older neonatal foals. Recognition of these changes may have implications for accurate CT interpretation in sedated neonatal foals with pulmonary disease.
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Affiliation(s)
- Kara M Lascola
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL 61802, USA
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L’oxygénothérapie dans tous ces états ou comment administrer l’oxygène en 2014 ? MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-014-0839-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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140
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Parke RL, McGuinness SP, Milne D, Jull A. A new system for assessing atelectasis on chest x-ray after sternotomy for cardiac surgery. ACTA ACUST UNITED AC 2014. [DOI: 10.7243/2054-1945-2-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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142
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Alveolar recruitment during mechanical ventilation – Where are we in 2013? TRENDS IN ANAESTHESIA AND CRITICAL CARE 2013. [DOI: 10.1016/j.tacc.2013.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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143
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Rovira Soriano L, Belda Nácher J. Postoperative respiratory management of morbidly obese patient. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2013. [DOI: 10.1016/j.tacc.2012.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
General anesthesia and surgery are associated with changes in the shape of the chest that result in atelectasis, a major factor in the development of postoperative respiratory failure. Postoperative noninvasive positive pressure ventilation (NIPPV) has been shown to improve oxygenation and ventilation for high-risk patients. NIPPV has been used as rescue therapy for patients developing acute respiratory distress postoperatively, and appears to be most frequently successful in patients whose problem is atelectasis or obesity. Failure to respond to NIPPV after 20 minutes is usually an indication of intubation, mechanical ventilation, and transfer to the intensive care unit.
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Affiliation(s)
- Patrick J Neligan
- Department of Anesthesia & Intensive Care, Galway University Hospitals, Newcastle Road, Galway, Ireland.
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145
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Staehr AK, Meyhoff CS, Henneberg SW, Christensen PL, Rasmussen LS. Influence of perioperative oxygen fraction on pulmonary function after abdominal surgery: a randomized controlled trial. BMC Res Notes 2012; 5:383. [PMID: 22840231 PMCID: PMC3434073 DOI: 10.1186/1756-0500-5-383] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 07/28/2012] [Indexed: 12/20/2022] Open
Abstract
Background A high perioperative inspiratory oxygen fraction (FiO2) may reduce the frequency of surgical site infection. Perioperative atelectasis is caused by absorption, compression and reduced function of surfactant. It is well accepted, that ventilation with 100% oxygen for only a few minutes is associated with significant formation of atelectasis. However, it is still not clear if a longer period of 80% oxygen results in more atelectasis compared to a low FiO2. Our aim was to assess if a high FiO2 is associated with impaired oxygenation and decreased pulmonary functional residual capacity (FRC). Methods Thirty-five patients scheduled for laparotomy for ovarian cancer were randomized to receive either 30% oxygen (n = 15) or 80% oxygen (n = 20) during and for 2 h after surgery. The oxygenation index (PaO2/FiO2) was measured every 30 min during anesthesia and 90 min after extubation. FRC was measured the day before surgery and 2 h after extubation by a rebreathing method using the inert gas SF6. Results Five min after intubation, the median PaO2/FiO2 was 69 kPa [53-71] in the 30%-group vs. 60 kPa [47-69] in the 80%-group (P = 0.25). At the end of anesthesia, the PaO2/FiO2 was 58 kPa [40-70] vs. 57 kPa [46-67] in the 30%- and 80%-group, respectively (P = 0.10). The median FRC was 1993 mL [1610-2240] vs. 1875 mL [1545-2048] at baseline and 1615 mL [1375-2318] vs. 1633 mL [1343-1948] postoperatively in the 30%- and 80%-group, respectively (P = 0.70). Conclusion We found no significant difference in oxygenation index or functional residual capacity between patients given 80% and 30% oxygen for a period of approximately 5 hours. Trial registration ClinicalTrials.gov Identifier: NCT00637936.
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Affiliation(s)
- Anne K Staehr
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen Ø, Denmark.
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Henao-Guerrero N, Ricco C, Jones JC, Buechner-Maxwell V, Daniel GB. Comparison of four ventilatory protocols for computed tomography of the thorax in healthy cats. Am J Vet Res 2012; 73:646-53. [DOI: 10.2460/ajvr.73.5.646] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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147
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148
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Delay JM, Jaber S. [Respiratory preparation before surgery in patients with chronic respiratory failure]. Presse Med 2011; 41:225-33. [PMID: 22004791 DOI: 10.1016/j.lpm.2011.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 07/23/2011] [Accepted: 08/25/2011] [Indexed: 11/17/2022] Open
Abstract
Scheduled and/or thoracic, abdominal surgeries increase the risk of respiratory postoperative complications. In patients with chronic respiratory failure, preoperative evaluation should be performed to evaluate respiratory function in aim to optimize perioperative management. Preoperative gas exchange abnormalities (hypoxemia or hypercapnia) are associated with respiratory postoperative complications. Respiratory physiotherapy and prophylactic non-invasive ventilation should be integrated in a global rehabilitation management for cardiothoracic or abdominal surgery procedures, which are at high risk of postoperative respiratory dysfunction. Stopping tobacco consummation should be benefit, but decease risk of postoperative complications is relevant only after a period for 6 to 8 weeks of cessation. Bronchodilatator aerosol therapy (beta-agonists and atropinics) and inhaled corticotherapy allow a rapid preparation for 24 to 48 h. Systematic preoperative antibiotherapy should not be recommended.
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Affiliation(s)
- Jean-Marc Delay
- CHU de Montpellier, hôpital Saint-Éloi, département d'anesthésie-réanimation Saint-Éloi (DAR B), 34295 Montpellier, France
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Remístico PPJ, Araújo S, de Figueiredo LC, Aquim EE, Gomes LM, Sombrio ML, Ambiel SDF. Impact of alveolar recruitment maneuver in the postoperative period of videolaparoscopic bariatric surgery. Rev Bras Anestesiol 2011; 61:163-8, 169-76, 88-94. [PMID: 21474024 DOI: 10.1016/s0034-7094(11)70021-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 09/09/2010] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pulmonary complications in bariatric surgery are common and, therefore, alveolar recruitment maneuvers (ARM) have been used to prevent or reduce them in the postoperative period (POP). The aim of this study was to evaluate the impact of ARM performed intraoperatively in patients undergoing bariatric surgery by videolaparoscopy in the incidence of postoperative pulmonary complications. METHODS Randomized clinical trial with 30 patients divided into control group (CG) and experimental group (EG), with analysis of spirometric, ventilatory, hemodynamic, and radiographic variables. ARM was performed in EG with positive end expiratory pressure of 30 cmH₂O and inspiratory plateau pressure of 45 cmH₂O for 2 minutes after pneumoperitoneum deflation. RESULTS We observed a significant decrease in spirometric values (p ≤ 0.001) and higher incidence of pulmonary complications on chest radiograph (p=0.02) in CG, as well as significant improvement in dyspnoea Borg scale (p ≤ 0.001) in EG. CONCLUSIONS We conclude that ARM is a safe and effective technique when used for prevention of pulmonary complications in patients undergoing bariatric surgery, resulting in more favorable radiological and spirometric findings in the experimental group compared to the control group in the PO.
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Affiliation(s)
- Paula Patelli Juliani Remístico
- Faculty of Medical Sciences, Universidade Estadual de Campinas Rua Tessália Vieira de Camargo, 126 Cidade Universitária "Zeferino Vaz" 13083-887, PO Box 6111-Campinas, SP, Brazil.
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Elke G, Pulletz S, Schädler D, Zick G, Gawelczyk B, Frerichs I, Weiler N. Measurement of regional pulmonary oxygen uptake—a novel approach using electrical impedance tomography. Physiol Meas 2011; 32:877-86. [DOI: 10.1088/0967-3334/32/7/s11] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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