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Young E, Nocera TM, Reilly M, Tobias JD, D’Mello A. An in vitro technique to measure resistance to compression and kinking of endotracheal tubes. Saudi J Anaesth 2024; 18:331-337. [PMID: 39149727 PMCID: PMC11323910 DOI: 10.4103/sja.sja_15_24] [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: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 08/17/2024] Open
Abstract
Background During intraoperative care, ventilatory parameters including peak inflating pressure (PIP) and exhaled tidal volumes are continuously monitored to assess changes in respiratory resistance and compliance. Changes in these parameters, such as an increase in PIP or a decrease in the exhaled tidal volume, may indicate various pathologic processes that may require immediate attention to prevent inadequate ventilation resulting in hypoxemia or hypercarbia. A kinked endotracheal tube (ETT) may mimic other pathologic processes including bronchospasm, mainstem intubation, or ventilator malfunction. As newer ETTs are developed, a key factor in their design should be resistance to kinking or occlusion due to patient positioning. Methods The current project developed and describes the process for using a repeatable in vitro mechanical test to determine resistance to kinking by an ETT. Results The mechanical testing procedure can be used to determine the compression force and distance required to kink an ETT under different conditions including temperature. The force required to induce devastating kink failure was lower during heated testing conditions. The addition of airflow through the ETTs during compression testing confirms the occurrence of airway obstruction at approximately the same time a mechanical kink is observed on the force-versus-distance curves. Conclusions These procedures may be used to characterize and evaluate ETT designs under in vitro conditions mimicking those in the clinical practice.
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Affiliation(s)
- Emily Young
- Wright State University Boonshoft School of Medicine, Dayton, Ohio, United States of America
| | - Tonya M. Nocera
- School of Engineering, The Ohio State University, Columbus, Ohio, United States of America
| | - Matthew Reilly
- School of Engineering, The Ohio State University, Columbus, Ohio, United States of America
| | - Joseph D. Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Ajay D’Mello
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, Ohio, United States of America
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Ballók B, Schranc Á, Tóth I, Somogyi P, Tolnai J, Peták F, Fodor GH. Comparison of the respiratory effects of commonly utilized general anaesthesia regimes in male Sprague-Dawley rats. Front Physiol 2023; 14:1249127. [PMID: 37791348 PMCID: PMC10544940 DOI: 10.3389/fphys.2023.1249127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/05/2023] [Indexed: 10/05/2023] Open
Abstract
Background: Respiratory parameters in experimental animals are often characterised under general anaesthesia. However, anaesthesia regimes may alter the functional and mechanical properties of the respiratory system. While most anaesthesia regimes have been shown to affect the respiratory system, the effects of general anaesthesia protocols commonly used in animal models on lung function have not been systematically compared. Methods: The present study comprised 40 male Sprague-Dawley rats divided into five groups (N = 8 in each) according to anaesthesia regime applied: intravenous (iv) Na-pentobarbital, intraperitoneal (ip) ketamine-xylazine, iv propofol-fentanyl, inhaled sevoflurane, and ip urethane. All drugs were administered at commonly used doses. End-expiratory lung volume (EELV), airway resistance (Raw) and tissue mechanics were measured in addition to arterial blood gas parameters during mechanical ventilation while maintaining positive end-expiratory pressure (PEEP) values of 0, 3, and 6 cm H2O. Respiratory mechanics were also measured during iv methacholine (MCh) challenges to assess bronchial responsiveness. Results: While PEEP influenced baseline respiratory mechanics, EELV and blood gas parameters (p < 0.001), no between-group differences were observed (p > 0.10). Conversely, significantly lower doses of MCh were required to achieve the same elevation in Raw under ketamine-xylazine anaesthesia compared to the other groups. Conclusion: In the most frequent rodent model of respiratory disorders, no differences in baseline respiratory mechanics or function were observed between commonly used anaesthesia regimes. Bronchial hyperresponsiveness in response to ketamine-xylazine anaesthesia should be considered when designing experiments using this regime. The findings of the present study indicate commonly used anaesthetic regimes allow fair comparison of respiratory mechanics in experimental animals undergoing any of the examined anaesthesia protocols.
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Affiliation(s)
- Bence Ballók
- Department of Medical Physics and Informatics, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Álmos Schranc
- Department of Medical Physics and Informatics, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- Unit for Anaesthesiological Investigations, Department of Anaesthesiology, Pharmacology, Intensive Care, and Emergency Medicine, University of Geneva, Geneva, Switzerland
| | - Ibolya Tóth
- Department of Medical Physics and Informatics, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Petra Somogyi
- Department of Medical Physics and Informatics, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- Department of Cell Biology and Molecular Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - József Tolnai
- Department of Medical Physics and Informatics, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Ferenc Peták
- Department of Medical Physics and Informatics, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Gergely H. Fodor
- Department of Medical Physics and Informatics, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
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Fogagnolo A, Montanaro F, Al-Husinat L, Turrini C, Rauseo M, Mirabella L, Ragazzi R, Ottaviani I, Cinnella G, Volta CA, Spadaro S. Management of Intraoperative Mechanical Ventilation to Prevent Postoperative Complications after General Anesthesia: A Narrative Review. J Clin Med 2021; 10:jcm10122656. [PMID: 34208699 PMCID: PMC8234365 DOI: 10.3390/jcm10122656] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 01/02/2023] Open
Abstract
Mechanical ventilation (MV) is still necessary in many surgical procedures; nonetheless, intraoperative MV is not free from harmful effects. Protective ventilation strategies, which include the combination of low tidal volume and adequate positive end expiratory pressure (PEEP) levels, are usually adopted to minimize the ventilation-induced lung injury and to avoid post-operative pulmonary complications (PPCs). Even so, volutrauma and atelectrauma may co-exist at different levels of tidal volume and PEEP, and therefore, the physiological response to the MV settings should be monitored in each patient. A personalized perioperative approach is gaining relevance in the field of intraoperative MV; in particular, many efforts have been made to individualize PEEP, giving more emphasis on physiological and functional status to the whole body. In this review, we summarized the latest findings about the optimization of PEEP and intraoperative MV in different surgical settings. Starting from a physiological point of view, we described how to approach the individualized MV and monitor the effects of MV on lung function.
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Affiliation(s)
- Alberto Fogagnolo
- Department of Translation Medicine and for Romagna, Section of Anesthesia and Intensive Care, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (C.T.); (R.R.); (I.O.); (C.A.V.); (S.S.)
- Correspondence:
| | - Federica Montanaro
- Department of Translation Medicine and for Romagna, Section of Anesthesia and Intensive Care, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (C.T.); (R.R.); (I.O.); (C.A.V.); (S.S.)
| | - Lou’i Al-Husinat
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan;
| | - Cecilia Turrini
- Department of Translation Medicine and for Romagna, Section of Anesthesia and Intensive Care, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (C.T.); (R.R.); (I.O.); (C.A.V.); (S.S.)
| | - Michela Rauseo
- Department of Anesthesia and Intensive Care, University of Foggia, 71122 Foggia, Italy; (M.R.); (L.M.); (G.C.)
| | - Lucia Mirabella
- Department of Anesthesia and Intensive Care, University of Foggia, 71122 Foggia, Italy; (M.R.); (L.M.); (G.C.)
| | - Riccardo Ragazzi
- Department of Translation Medicine and for Romagna, Section of Anesthesia and Intensive Care, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (C.T.); (R.R.); (I.O.); (C.A.V.); (S.S.)
| | - Irene Ottaviani
- Department of Translation Medicine and for Romagna, Section of Anesthesia and Intensive Care, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (C.T.); (R.R.); (I.O.); (C.A.V.); (S.S.)
| | - Gilda Cinnella
- Department of Anesthesia and Intensive Care, University of Foggia, 71122 Foggia, Italy; (M.R.); (L.M.); (G.C.)
| | - Carlo Alberto Volta
- Department of Translation Medicine and for Romagna, Section of Anesthesia and Intensive Care, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (C.T.); (R.R.); (I.O.); (C.A.V.); (S.S.)
| | - Savino Spadaro
- Department of Translation Medicine and for Romagna, Section of Anesthesia and Intensive Care, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (C.T.); (R.R.); (I.O.); (C.A.V.); (S.S.)
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Chun EH, Baik HJ, Moon HS, Jeong K. Comparison of low and high positive end-expiratory pressure during low tidal volume ventilation in robotic gynaecological surgical patients using electrical impedance tomography. Eur J Anaesthesiol 2019; 36:641-648. [DOI: 10.1097/eja.0000000000001047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Huynh TT, Liesching TN, Cereda M, Lei Y, Frazer MJ, Nahouraii MR, Diette GB. Efficacy of Oscillation and Lung Expansion in Reducing Postoperative Pulmonary Complication. J Am Coll Surg 2019; 229:458-466.e1. [PMID: 31362061 DOI: 10.1016/j.jamcollsurg.2019.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postoperative pulmonary complications (PPCs) cause high morbidity and mortality. Targeted treatment for patients at risk for PPCs can improve outcomes. This multicenter prospective trial examined the impact of oscillation and lung expansion (OLE) therapy, using continuous high-frequency oscillation and continuous positive expiratory pressure on PPCs in high-risk patients. METHODS In stage I, CPT and ICD codes were queried for patients (n = 210) undergoing thoracic, upper abdominal, or aortic open procedures at 3 institutions from December 2014 to April 2016. Patients were selected randomly. Age, comorbidities, American Society of Anesthesiologists physical status classification scores, and PPC rates were determined. In stage II, 209 subjects were enrolled prospectively from October 2016 to July 2017 using the same criteria. Stage II subjects received OLE treatment and standard respiratory care. The PPCs rate (prolonged ventilation, high-level respiratory support, pneumonia, ICU readmission) were compared. We also compared ICU length of stay (LOS), hospital LOS, and mortality using t-tests and analysis of covariance. Data are mean ± SD. RESULTS There were 419 subjects. Stage II patients were older (61.1 ± 13.7 years vs 57.4 ± 15.5 years; p < 0.05) and had higher American Society of Anesthesiologists scores. Treatment with OLE decreased PPCs from 22.9% (stage I) to 15.8% (stage II) (p < 0.01 adjusted for age, American Society of Anesthesiologists score, and operation time). Similarly, OLE treatment reduced ventilator time (23.7 ± 107.5 hours to 8.5 ± 27.5 hours; p < 0.05) and hospital LOS (8.4 ± 7.9 days to 6.8 ± 5.0 days; p < 0.05). No differences in ICU LOS, pneumonia, or mortality were observed. CONCLUSIONS Aggressive treatment with OLE reduces PPCs and resource use in high-risk surgical patients.
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Affiliation(s)
- Toan T Huynh
- Division of Acute Care Surgery, The FH "Sammy" Ross Jr Trauma Center, Carolinas Medical Center, Atrium Health, Charlotte, NC.
| | - Timothy N Liesching
- Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, MA
| | - Maurizio Cereda
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Yuxiu Lei
- Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, MA
| | - Michael J Frazer
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Michael R Nahouraii
- Division of Acute Care Surgery, The FH "Sammy" Ross Jr Trauma Center, Carolinas Medical Center, Atrium Health, Charlotte, NC
| | - Gregory B Diette
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD
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Celeita-Rodríguez N, Teixeira-Neto FJ, Garofalo NA, Dalmagro TL, Girotto CH, Oliveira GCV, Santos IF. Comparison of the diagnostic accuracy of dynamic and static preload indexes to predict fluid responsiveness in mechanically ventilated, isoflurane anesthetized dogs. Vet Anaesth Analg 2019; 46:276-288. [PMID: 30979542 DOI: 10.1016/j.vaa.2018.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 12/03/2018] [Accepted: 12/12/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the diagnostic accuracy of pulse pressure variation (PPV), stroke volume variation from pulse contour analysis (SVVPCA), plethysmographic variability index (PVI), central venous pressure (CVP) and global end-diastolic volume index measured by transpulmonary thermodilution (GEDVITPTD) to predict fluid responsiveness (FR) in dogs. STUDY DESIGN Prospective study. ANIMALS A group of 40 bitches (13.8-26.8 kg) undergoing ovariohysterectomy. METHODS Anesthesia was maintained with isoflurane under volume-controlled ventilation (tidal volume 12 mL kg-1; inspiratory pause during 40% of inspiratory time; inspiration:expiration ratio 1:1.5). Transpulmonary thermodilution cardiac output was recorded through a femoral artery catheter. FR was evaluated by a fluid challenge (lactated Ringer's, 20 mL kg-1 over 15 minutes) administered once (n = 21) or twice (n = 18) before surgery. Individuals were responders if stroke volume index measured by transpulmonary thermodilution increased >15% after the last fluid challenge. RESULTS Of the 39 animals studied, 21 were responders and 18 were nonresponders. Area under the receiver operating characteristics curve (AUROC) was 0.976, 0.906, 0.868 and 0.821 for PPV, PVI, CVP and SVVPCA, respectively (p < 0.0001 from AUROC = 0.5). GEDVITPTD failed to predict FR (AUROC: 0.660, p = 0.078). Best cut-off thresholds discriminating responders and nonresponders, with respective zones of diagnostic uncertainty (gray zones) were: PPV >16% (15-16%), PVI >11% (10-13%), SVVPCA >10% (9-18%) and CVP ≤1 mmHg (0-3 mmHg). Percentage of animals within gray zone limits was 13% (PPV), 28% (PVI), 51% (SVVPCA) and 67% (CVP). CONCLUSIONS AND CLINICAL RELEVANCE PPV has better diagnostic accuracy to predict FR (conclusive results in nearly 90% of population) than other preload indexes in healthy dogs. When invasive blood pressure is unavailable, PVI will predict FR with reasonable accuracy (conclusive results in approximately 70% of the population). PPV and PVI values above gray zone limits (>16% and >13%, respectively) can reliably predict responders to volume expansion.
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Affiliation(s)
| | - Francisco J Teixeira-Neto
- Faculdade de Medicina, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil; Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil.
| | - Natache A Garofalo
- Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Tábata L Dalmagro
- Faculdade de Medicina, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Carolina H Girotto
- Faculdade de Medicina, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | | | - Ivan Fc Santos
- Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
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Restrepo RD, Braverman J. Current challenges in the recognition, prevention and treatment of perioperative pulmonary atelectasis. Expert Rev Respir Med 2014; 9:97-107. [DOI: 10.1586/17476348.2015.996134] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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A comparison of the incidence of hypercapnea in non-obese and morbidly obese peri-operative patients using the SenTec transcutaneous pCO2 monitor. J Clin Monit Comput 2013; 28:293-8. [DOI: 10.1007/s10877-013-9534-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 11/15/2013] [Indexed: 11/26/2022]
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Dasgupta CS, Kar SK, Goswami A, Dutta S, Sarkar UN. Effect of low volume ventilation during cardiopulmonary bypass on oxygenation and postoperative pulmonary outcome. Indian J Thorac Cardiovasc Surg 2013. [DOI: 10.1007/s12055-012-0168-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Grade M, Quintel M, Ghadimi BM. Standard perioperative management in gastrointestinal surgery. Langenbecks Arch Surg 2011; 396:591-606. [PMID: 21448724 PMCID: PMC3101361 DOI: 10.1007/s00423-011-0782-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 03/08/2011] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The outcome of patients who are scheduled for gastrointestinal surgery is influenced by various factors, the most important being the age and comorbidities of the patient, the complexity of the surgical procedure and the management of postoperative recovery. To improve patient outcome, close cooperation between surgeons and anaesthesiologists (joint risk assessment) is critical. This cooperation has become increasingly important because more and more patients are being referred to surgery at an advanced age and with multiple comorbidities and because surgical procedures and multimodal treatment modalities are becoming more and more complex. OBJECTIVE The aim of this review is to provide clinicians with practical recommendations for day-to-day decision-making from a joint surgical and anaesthesiological point of view. The discussion centres on gastrointestinal surgery specifically.
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Affiliation(s)
- Marian Grade
- Department of General and Visceral Surgery, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Michael Quintel
- Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - B. Michael Ghadimi
- Department of General and Visceral Surgery, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany
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What is the outcome of intraoperative management? Eur J Anaesthesiol 2009; 27:85; author reply 85-6. [PMID: 19734789 DOI: 10.1097/eja.0b013e328331e122] [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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