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Mato-Búa R, Prado-Rodríguez A, López-López D, Rama-Maceiras P, Molins-Gauna N, Álvarez-Refojo F. Intraoperative effects of an alveolar recruitment manoeuvre in patients undergoing laparoscopic colon surgery. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:151-159. [PMID: 38452926 DOI: 10.1016/j.redare.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Pulmonary atelectasis is common in patients undergoing laparoscopic abdominal surgery under general anaesthesia, which increases the risk of perioperative respiratory complications. Alveolar recruitment manoeuvres (ARM) are used to open up the lung parenchyma with atelectasis, although the duration of their benefit has not been clearly established. The aim of this study was to determine the effectiveness of an ARM in laparoscopic colon surgery, the duration of response over time, and its haemodynamic impact. METHODS Twenty-five patients undergoing laparoscopic colon surgery were included. After anaesthetic induction and initiation of surgery with pneumoperitoneum, an ARM was performed, and then optimal PEEP determined. Respiratory mechanics and gas exchange variables, and haemodynamic parameters, were analysed before the manoeuvre and periodically over the following 90 min. RESULTS Three patients were excluded for surgical reasons. The alveolar arterial oxygen gradient went from 94.3 (62.3-117.8) mmHg before to 60.7 (29.6-91.0) mmHg after the manoeuvre (P < .05). This difference was maintained during the 90 min of the study. Dynamic compliance of the respiratory system went from 31.3 ml/cmH2O (26.1-39.2) before the manoeuvre to 46.1 ml/cmH2O (37.5-53.5) after the manoeuvre (P < .05). This difference was maintained for 60 min. No significant changes were identified in any of the haemodynamic variables studied. CONCLUSION In patients undergoing laparoscopic colon surgery, performing an intraoperative ARM improves the mechanics of the respiratory system and oxygenation, without associated haemodynamic compromise. The benefit of these manoeuvres lasts for at least one hour.
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Affiliation(s)
- R Mato-Búa
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain.
| | - A Prado-Rodríguez
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - D López-López
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - P Rama-Maceiras
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - N Molins-Gauna
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - F Álvarez-Refojo
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
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Torre Oñate T, Romero Berrocal A, Bilotta F, Badenes R, Santos Gonzalez M, de Reina Perez L, Garcia Fernandez J. Impact of Stepwise Recruitment Maneuvers on Cerebral Hemodynamics: Experimental Study in Neonatal Model. J Pers Med 2023; 13:1184. [PMID: 37623435 PMCID: PMC10456108 DOI: 10.3390/jpm13081184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Lung recruitment maneuvers (LRMs) have been demonstrated to be effective in avoiding atelectasis during general anesthesia in the pediatric population. Performing these maneuvers is safe at the systemic hemodynamic and respiratory levels. AIMS We aimed to evaluate the impact of a stepwise LRM and individualized positive end-expiratory pressure (PEEP) on cerebral hemodynamics in an experimental neonatal model. METHODS Eleven newborn pigs (less than 72 h old, 2.56 ± 0.18 kg in weight) were included in the study. The LRM was performed under pressure-controlled ventilation with a constant driving pressure (15 cmH2O) in a stepwise increasing PEEP model. The target peak inspiratory pressure (PIP) was 30 cmH2O and the PEEP was 15 cmH2O. The following hemodynamic variables were monitored using the PICCO® system: mean arterial pressure (MAP), central venous pressure (CVP), and cardiac output (CO). The cerebral hemodynamics variables monitored were intracranial pressure (ICP) (with an intraparenchymal Camino® catheter) and cerebral oxygen saturation (rSO2) (with the oximetry monitor INVOS 5100® system). The following respiratory parameters were monitored: oxygen saturation, fraction of inspired oxygen, partial pressure of oxygen, end-tidal carbon dioxide pressure, Pmean, PEEP, static compliance (Cstat), and dynamic compliance (Cdyn). RESULTS All LRMs were safely performed as scheduled without any interruptions. Systemic hemodynamic stability was maintained during the lung recruitment maneuver. No changes in ICP occurred. We observed an improvement in rSO2 after the maneuver (+5.8%). CONCLUSIONS Stepwise LRMs are a safe tool to avoid atelectasis. We did not observe an impairment in cerebral hemodynamics but an improvement in cerebral oxygenation.
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Affiliation(s)
- Teresa Torre Oñate
- Department of Anaesthesiology, Intensive Care and Pain, Hospital Universitario Puerta de Hierro en Majadahonda, 28222 Majadahonda, Spain; (A.R.B.); (J.G.F.)
| | - Antonio Romero Berrocal
- Department of Anaesthesiology, Intensive Care and Pain, Hospital Universitario Puerta de Hierro en Majadahonda, 28222 Majadahonda, Spain; (A.R.B.); (J.G.F.)
| | - Federico Bilotta
- Department of Anaesthesiology and Intensive Care, Sapienza University of Rome, 00185 Rome, Italy;
| | - Rafael Badenes
- Department of Anaesthesiology, Intensive Care and Pain, Hospital Clinic Universitari en Valencia, University of Valencia, 46010 Valencia, Spain;
| | - Martin Santos Gonzalez
- Medical and Surgical Research Unit, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Hospital Universitario Puerta de Hierro en Majadahonda, 28222 Majadahonda, Spain;
| | - Laura de Reina Perez
- Department of Neurosurgery, Hospital Universitario Puerta de Hierro en Majadahonda, 28222 Majadahonda, Spain;
| | - Javier Garcia Fernandez
- Department of Anaesthesiology, Intensive Care and Pain, Hospital Universitario Puerta de Hierro en Majadahonda, 28222 Majadahonda, Spain; (A.R.B.); (J.G.F.)
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Mor Conejo M, Guitart Pardellans C, Fresán Ruiz E, Penela Sánchez D, Cambra Lasaosa FJ, Jordan Garcia I, Balaguer Gargallo M, Pons-Òdena M. Lung Recruitment Maneuvers Assessment by Bedside Lung Ultrasound in Pediatric Acute Respiratory Distress Syndrome. CHILDREN 2022; 9:children9060789. [PMID: 35740726 PMCID: PMC9222064 DOI: 10.3390/children9060789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022]
Abstract
The use of recruitment maneuvers (RMs) is suggested to improve severe oxygenation failure in patients with acute respiratory distress syndrome (ARDS). Lung ultrasound (LUS) is a non-invasive, safe, and easily repeatable tool. It could be used to monitor the lung recruitment process in real-time. This paper aims to evaluate bedside LUS for assessing PEEP-induced pulmonary reaeration during RMs in pediatric patients. A case of a child with severe ARDS due to Haemophilus influenzae infection is presented. Due to his poor clinical, laboratory, and radiological evolution, he was placed on venovenous extracorporeal membrane oxygenation (ECMO). Despite all measures, severe pulmonary collapse prevented proper improvement. Thus, RMs were indicated, and bedside LUS was successfully used for monitoring and assessing lung recruitment. The initial lung evaluation before the maneuver showed a tissue pattern characterized by a severe loss of lung aeration with dynamic air bronchograms and multiple coalescent B-lines. While raising a PEEP of 30 mmH2O, LUS showed the presence of A-lines, which was considered a predictor of reaeration in response to the recruitment maneuver. The LUS pattern could be used to assess modifications in the lung aeration, evaluate the effectiveness of RMs, and prevent lung overdistension.
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Affiliation(s)
- Mireia Mor Conejo
- Pediatric Intensive Care Unit Service, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain; (M.M.C.); (C.G.P.); (E.F.R.); (D.P.S.); (F.J.C.L.); (I.J.G.)
| | - Carmina Guitart Pardellans
- Pediatric Intensive Care Unit Service, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain; (M.M.C.); (C.G.P.); (E.F.R.); (D.P.S.); (F.J.C.L.); (I.J.G.)
- Immune and Respiratory Dysfunction Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Elena Fresán Ruiz
- Pediatric Intensive Care Unit Service, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain; (M.M.C.); (C.G.P.); (E.F.R.); (D.P.S.); (F.J.C.L.); (I.J.G.)
- Immune and Respiratory Dysfunction Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Daniel Penela Sánchez
- Pediatric Intensive Care Unit Service, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain; (M.M.C.); (C.G.P.); (E.F.R.); (D.P.S.); (F.J.C.L.); (I.J.G.)
| | - Francisco José Cambra Lasaosa
- Pediatric Intensive Care Unit Service, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain; (M.M.C.); (C.G.P.); (E.F.R.); (D.P.S.); (F.J.C.L.); (I.J.G.)
- Immune and Respiratory Dysfunction Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Iolanda Jordan Garcia
- Pediatric Intensive Care Unit Service, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain; (M.M.C.); (C.G.P.); (E.F.R.); (D.P.S.); (F.J.C.L.); (I.J.G.)
- Immune and Respiratory Dysfunction Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain
- Pediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, CIBERESP, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Mònica Balaguer Gargallo
- Pediatric Intensive Care Unit Service, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain; (M.M.C.); (C.G.P.); (E.F.R.); (D.P.S.); (F.J.C.L.); (I.J.G.)
- Immune and Respiratory Dysfunction Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain
- Correspondence: (M.B.G.); (M.P.-Ò.)
| | - Martí Pons-Òdena
- Pediatric Intensive Care Unit Service, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain; (M.M.C.); (C.G.P.); (E.F.R.); (D.P.S.); (F.J.C.L.); (I.J.G.)
- Immune and Respiratory Dysfunction Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain
- Correspondence: (M.B.G.); (M.P.-Ò.)
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He P, Wu C, Yang Y, Zheng J, Dong W, Wu J, Sun Y, Zhang M. Effectiveness of postural lung recruitment on postoperative atelectasis assessed by lung ultrasound in children undergoing lateral thoracotomy cardiac surgery with cardiopulmonary bypass. Pediatr Pulmonol 2021; 56:1724-1732. [PMID: 33580585 DOI: 10.1002/ppul.25315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/05/2021] [Accepted: 02/08/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To assess the effects of postural lung recruitment maneuvers on the postoperative atelectasis assessed by lung ultrasound (LUS) compared with supine position recruitment maneuvers in children undergoing right lateral thoracotomy cardiac surgery with cardiopulmonary bypass. METHODS In this randomized and controlled trial, 84 patients aged 3 years or younger, scheduled for right lateral thoracotomy cardiac surgery with cardiopulmonary bypass (CPB) were randomly allocated to postural lung recruitment group or control group. The first LUS exam was performed immediately upon completion of the cardiac surgery (T1), and a repeat ultrasound exam started 1 min after lung recruitment maneuvers (T2). The primary outcome was the incidence of significant atelectasis at T2. RESULTS The incidence of significant atelectasis at T2 in the postural lung recruitment maneuver group was lower compared with that in the control group (30.2% vs. 58.1%; odds ratio: 0.31; 95% confidence interval: 0.13-0.76; p = .009). The LUS scores for consolidations and B-lines of the left lung were higher than those of the right lung in both groups at T1. More significant reduction of the left LUS scores and sizes of atelectatic areas were found in the postural lung recruitment group than those in the control group. CONCLUSIONS Postoperative postural recruitment maneuver was more effective to improve reaeration of lung than supine position recruitment maneuver in children undergoing right lateral thoracotomy cardiac surgery with CPB.
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Affiliation(s)
- Pan He
- Department of Anesthesiology, School of Medicine, Shanghai Children's Medical Centre, Shanghai Jiao Tong University, Shanghai, China
| | - Chi Wu
- Department of Anesthesiology, School of Medicine, Shanghai Children's Medical Centre, Shanghai Jiao Tong University, Shanghai, China
| | - Yanyan Yang
- Department of Anesthesiology, School of Medicine, Shanghai Children's Medical Centre, Shanghai Jiao Tong University, Shanghai, China
| | - Jijian Zheng
- Department of Anesthesiology, School of Medicine, Shanghai Children's Medical Centre, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Dong
- Department of Cardio-Thoracic Surgery, School of Medicine, Shanghai Children's Medical Centre, Shanghai Jiao Tong University, Shanghai, China
| | - Junzheng Wu
- Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
| | - Ying Sun
- Department of Anesthesiology, School of Medicine, Shanghai Children's Medical Centre, Shanghai Jiao Tong University, Shanghai, China
| | - Mazhong Zhang
- Department of Anesthesiology, School of Medicine, Shanghai Children's Medical Centre, Shanghai Jiao Tong University, Shanghai, China
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Halawa NM, Elshafie MA, Fernandez JG, Metwally AAR, Yassen KA. Respiratory and Hemodynamic Effects of Prophylactic Alveolar Recruitment During Liver Transplant: A Randomized Controlled Trial. EXP CLIN TRANSPLANT 2021; 19:462-472. [PMID: 33736584 DOI: 10.6002/ect.2020.0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Prolonged surgical retraction may cause atelectasis. We aimed to recruit collapsed alveoli, stepwise, monitored by lung dynamic compliance and observe effects on arterial oxygenation and systemic and graft hemodynamics. Secondarily, we observed alveolar recruitment effects on postoperative mechanical ventilation, international normalized ratio, and pulmonary complications. MATERIALS AND METHODS For 58 recipients (1 excluded), randomized with optimal positive end-expiratory pressure (n = 28) versus control (fixed positive end-expiratory pressure, 5 cm H₂O; n = 29), alveolar recruitment was initiated (pressure-controlled ventilation guided by lung dynamic compliance) to identify optimal conditions. Ventilation shifted to volume-control mode with 0.4 fraction of inspired oxygen, 6 mL/kg tidal volume, and 1:2 inspiratory-to-expiratory ratio. Alveolar recruitment was repeated postretraction and at intensive care unit admission. Primary endpoints were changes in lung dynamic compliance, arterial oxygenation, and hemodynamics (cardiac output, invasive arterial and central venous pressures, graft portal and hepatic vein flows). Secondary endpoints were mechanical ventilation period and postoperative international normalized ratio, aspartate/alanine aminotransferases, lactate, and pulmonary complications. RESULTS Alveolar recruitment increased positive end-expiratory pressure, lung dynamic compliance, and arterial oxygenation (P < .01) and central venous pressure (P = .004), without effects on corrected flow time (P = .7). Cardiac output and invasive arterial pressure were stable with (P = .11) and without alveolar recruitment (P = .1), as were portal (P = .27) and hepatic vein flow (P = .30). Alveolar recruitment reduced postoperative pulmonary complications (n = 0/28 vs 8/29; P = .001), without reduction in postoperative mechanical ventilation period (P = .08). International normalization ratio, aspartate/alanine aminotransferases, and lactate were not different from control (P > .05). CONCLUSIONS Stepwise alveolar recruitment identified the optimal positive end-expiratory pressure to improve lung mechanics and oxygenation with minimal hemodynamic changes, without liver graft congestion/dysfunction, and was associated with significant reduction in postoperative pulmonary complications.
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Affiliation(s)
- Naglaa Moustafa Halawa
- From the Anesthesia Department, National Liver Institute, Menoufia University, Sheeben Elkom City, Egypt
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Lan CC, Huang HK, Wu CP, Tu CC, Huang TW, Tsai WC, Tseng NC, Chang H. Recruitment maneuver leads to increased expression of pro-inflammatory cytokines in acute respiratory distress syndrome. Respir Physiol Neurobiol 2019; 271:103284. [PMID: 31472287 DOI: 10.1016/j.resp.2019.103284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 12/18/2022]
Abstract
Acute respiratory distress syndrome (ARDS) is a disease with high morbidity and mortality rates. The recruitment maneuver (RM) is one of the interventions used for ARDS patients suffering from severe hypoxemia. RM works by opening the atelectatic lungs using high transpulmonary pressure. RM has therefore been widely used for many years in patients with ARDS. However, because of the high transpulmonary pressure used in this intervention, there are concerns about both biotrauma and hemodynamic instability. To assess the effects of RM in ARDS, we conducted a study using three groups of pigs (n = 6 in each group): group I (control), group II (ARDS), and group III (ARDS with RM). After measuring the baseline values, ARDS was induced by deactivating the surfactant with 5% Tweens lavage. For pigs of group III, the RM protocol used was positive end-expiratory pressure (PEEP) of 25 cmH2O and peak pressure of 45 cmH2O. Gas exchange, hemodynamics, the expression of cytokines in serum, bronchoalveolar lavage fluid (BALF), and exhaled breath condensates (EBCs) were measured. The baseline measurements taken were similar across the three groups, and no significant difference was noted. After the induction of ARDS, PaO2 substantially decreased, while PaCO2, alveolar-arterial O2 gradient, pulmonary arterial pressure, lung water, level of cytokines in serum, EBCs, and BALF all increased. After RM, gas exchange and lung water level improved, but the level of cytokines in EBCs and BALF increased. Although RM led to an improvement in gas exchange, it may cause release of inflammatory cytokines in the EBCs and BALF.
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Affiliation(s)
- Chou-Chin Lan
- Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan; School of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Hsu-Kai Huang
- Department of Thoracic Surgery, Tri-Service General Hospital Taipei, National Defense Medical Center, Taiwan
| | - Chin-Pyng Wu
- Department of Critical Care Medicine, Landseed International Hospital, Tao-Yuan City, Taiwan
| | - Chuan-Chou Tu
- Department of Chest medicine, Taichung armed forces general hospital, National Defense Medical Center, Taiwan
| | - Tsai-Wang Huang
- Department of Thoracic Surgery, Tri-Service General Hospital Taipei, National Defense Medical Center, Taiwan
| | - Wen-Chiuan Tsai
- Department of Pathology, Tri-Service General Hospital Taipei, National Defense Medical Center, Taiwan
| | - Neng-Chuan Tseng
- Department of Nuclear Medicine, Taichung armed forces general hospital, Taiwan.
| | - Hung Chang
- Department of Thoracic Surgery, Tri-Service General Hospital Taipei, National Defense Medical Center, Taiwan.
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