Physiological changes occurring with positive pressure ventilation: Part one

The effect of positive end-expiratory pressure on inflammatory cytokines during laparoscopic cholecystectomy

Objectives:

To investigate effects of the positive end-expiratory pressure (PEEP) application of 10 cm H₂O on the plasma levels of cytokines during laparoscopic cholecystectomy.

Methods:

A prospective study was conducted on 40 patients who presented to the Department of General Surgery, Medical Faculty, Turgut Özal University, Ankara, Turkey scheduled for laparoscopic cholecystectomy operation during a 10 month period from September 2012 to June 2013. Forty patients scheduled for laparoscopic cholecystectomy operation were randomly divided into 2 groups; ventilation through zero end-expiratory pressure (ZEEP) (0 cm H₂O PEEP) (n=20), and PEEP (10 cm H₂O PEEP) (n=20). All patients were ventilated with 8 ml/kg TV. Levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α, IL 10, and transforming growth factor (TGF)-β1 were measured in the pre- and post-operatively collected samples.

Results:

Blood samples of 30 patients’ were analyzed for plasma cytokine levels, and 10 were excluded from the study due to hemolysis. Post-operative plasma IL-6 levels were observed to be significantly higher than the pre-operative patients (p=0.035). Post-operative plasma TGF-β1 levels in the PEEP group was found significantly higher compared with the pre-operative group levels (p=0.033). However, there were no significant differences in the pre- and post-operative plasma cytokine levels between the 2 groups.

Conclusion:

The application of PEEP of 10 cm H₂O, which has known beneficial effect on respiratory mechanics, does not have any effect on systemic inflammatory response undergoing pneumoperitoneum during laparoscopic cholecystectomy surgery.

Exploring the evidence base of the use of non-invasive ventilation

Chronic obstructive pulmonary disease (COPD) has a prevalence rate of between 4-10% in the UK (Halbert et al, 2003) and as such accounts for a large number of hospital admissions each year. Non-invasive ventilation (NIV) is now increasingly used to treat exacerbations of this condition and therefore nurses caring for these patients need an understanding of the rationale behind its instigation. This article reviews the literature pertaining to the use of NIV in the patient with COPD and provides a critique of the research available. The implications for practice have been highlighted through a discussion regarding the nursing management of the patient on NIV.

Clinical skills: a care plan approach to nurse-led extubation

Long-term mechanical ventilation (in patients who require mechanical ventilation for longer than 24 hours) has been associated with prolonged anxiety, chest infections and high mortality rates. Prolonged mechanical ventilation is also costly, as it tends to be carried out in critical care environments which require high levels of staffing. Therefore, it would appear to be of great benefit to patients, relatives and all multidisciplinary healthcare professionals concerned in delivering respiratory care if patient ventilation was kept as brief as possible. Current opinions seem to suggest that nurses can be the key players in reducing the time on a mechanical ventilator for patients and can take the lead on the extubation process of ventilatory weaning.