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Luo Y, Li J, Ding Q, Wang H, Liu C, Wu J. Functionalized Hydrogel-Based Wearable Gas and Humidity Sensors. NANO-MICRO LETTERS 2023; 15:136. [PMID: 37225851 PMCID: PMC10209388 DOI: 10.1007/s40820-023-01109-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/13/2023] [Indexed: 05/26/2023]
Abstract
Breathing is an inherent human activity; however, the composition of the air we inhale and gas exhale remains unknown to us. To address this, wearable vapor sensors can help people monitor air composition in real time to avoid underlying risks, and for the early detection and treatment of diseases for home healthcare. Hydrogels with three-dimensional polymer networks and large amounts of water molecules are naturally flexible and stretchable. Functionalized hydrogels are intrinsically conductive, self-healing, self-adhesive, biocompatible, and room-temperature sensitive. Compared with traditional rigid vapor sensors, hydrogel-based gas and humidity sensors can directly fit human skin or clothing, and are more suitable for real-time monitoring of personal health and safety. In this review, current studies on hydrogel-based vapor sensors are investigated. The required properties and optimization methods of wearable hydrogel-based sensors are introduced. Subsequently, existing reports on the response mechanisms of hydrogel-based gas and humidity sensors are summarized. Related works on hydrogel-based vapor sensors for their application in personal health and safety monitoring are presented. Moreover, the potential of hydrogels in the field of vapor sensing is elucidated. Finally, the current research status, challenges, and future trends of hydrogel gas/humidity sensing are discussed.
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Affiliation(s)
- Yibing Luo
- State Key Laboratory of Optoelectronic Materials and Technologies and the Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510275, People's Republic of China
| | - Jianye Li
- State Key Laboratory of Optoelectronic Materials and Technologies and the Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510275, People's Republic of China
| | - Qiongling Ding
- State Key Laboratory of Optoelectronic Materials and Technologies and the Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510275, People's Republic of China
| | - Hao Wang
- State Key Laboratory of Optoelectronic Materials and Technologies and the Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510275, People's Republic of China
| | - Chuan Liu
- State Key Laboratory of Optoelectronic Materials and Technologies and the Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510275, People's Republic of China
| | - Jin Wu
- State Key Laboratory of Optoelectronic Materials and Technologies and the Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510275, People's Republic of China.
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Jimenez-Tellez N, Pehar M, Visser F, Casas-Ortiz A, Rice T, Syed NI. Sevoflurane Exposure in Neonates Perturbs the Expression Patterns of Specific Genes That May Underly the Observed Learning and Memory Deficits. Int J Mol Sci 2023; 24:ijms24108696. [PMID: 37240038 DOI: 10.3390/ijms24108696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/20/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Exposure to commonly used anesthetics leads to neurotoxic effects in animal models-ranging from cell death to learning and memory deficits. These neurotoxic effects invoke a variety of molecular pathways, exerting either immediate or long-term effects at the cellular and behavioural levels. However, little is known about the gene expression changes following early neonatal exposure to these anesthetic agents. We report here on the effects of sevoflurane, a commonly used inhalational anesthetic, on learning and memory and identify a key set of genes that may likely be involved in the observed behavioural deficits. Specifically, we demonstrate that sevoflurane exposure in postnatal day 7 (P7) rat pups results in subtle, but distinct, memory deficits in the adult animals that have not been reported previously. Interestingly, when given intraperitoneally, pre-treatment with dexmedetomidine (DEX) could only prevent sevoflurane-induced anxiety in open field testing. To identify genes that may have been altered in the neonatal rats after sevoflurane and DEX exposure, specifically those impacting cellular viability, learning, and memory, we conducted an extensive Nanostring study examining over 770 genes. We found differential changes in the gene expression levels after exposure to both agents. A number of the perturbed genes found in this study have previously been implicated in synaptic transmission, plasticity, neurogenesis, apoptosis, myelination, and learning and memory. Our data thus demonstrate that subtle, albeit long-term, changes observed in an adult animal's learning and memory after neonatal anesthetic exposure may likely involve perturbation of specific gene expression patterns.
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Affiliation(s)
- Nerea Jimenez-Tellez
- Department of Biochemistry and Molecular Biology, University of Calgary, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Marcus Pehar
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Frank Visser
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Alberto Casas-Ortiz
- Department of Biochemistry and Molecular Biology, University of Calgary, Calgary, AB T2N 4N1, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Tiffany Rice
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Naweed I Syed
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Cell Biology and Anatomy, University of Calgary, Calgary, AB T2N 4N1, Canada
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Choi C, Lemmink G, Humanez J. Postoperative Respiratory Failure and Advanced Ventilator Settings. Anesthesiol Clin 2023; 41:141-159. [PMID: 36871996 DOI: 10.1016/j.anclin.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Postoperative respiratory failure has a multifactorial etiology, of which atelectasis is the most common mechanism. Its injurious effects are magnified by surgical inflammation, high driving pressures, and postoperative pain. Chest physiotherapy and noninvasive ventilation are good options to prevent progression of respiratory failure. Acute respiratory disease syndrome is a late and severe finding, which is associated with high morbidity and mortality. If present, proning is a safe, effective, and underutilized therapy. Extracorporeal membrane oxygenation is an option only when traditional supportive measures have failed.
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Affiliation(s)
- Christopher Choi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9068, USA.
| | - Gretchen Lemmink
- Department of Anesthesiology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0531, USA
| | - Jose Humanez
- Department of Anesthesiology, University of Florida College of Medicine - Jacksonville, 655 West 8th Street, C72, Jacksonville, FL 32209, USA
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Ramos M, Tau Anzoategui S. Preoxygenation: from hardcore physiology to the operating room. J Anesth 2022; 36:770-781. [PMID: 36136165 DOI: 10.1007/s00540-022-03105-z] [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: 02/01/2022] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
Abstract
If we define the human body by the mass of the elements that compose it, we could say that we are oxygen and other elements. Oxygen, in addition to being fundamental in our composition, is an element that we constantly need to support cellular respiration and, therefore, life. Interestingly, despite its importance, humans have not developed mechanisms that allow us to store it and, therefore, we are unable to sustain life if we are deprived of ventilation, even for brief periods. Accordingly, the ability to induce the cessation of ventilation in a patient must be accompanied by different technical and non-technical skills that allow the patient's safety to be maintained in this highly vulnerable state. Through the use of basic mathematical tools and comparative physiology, we hereby propose to review the physiological foundations of preoxygenation to understand the reasons behind the clinical recommendations in this field.
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Affiliation(s)
- Matias Ramos
- Department of Anesthesiology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina.
| | - Santiago Tau Anzoategui
- Department of Anesthesiology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
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The effects of laryngeal mask airway versus endotracheal tube on atelectasis in patients undergoing general anesthesia assessed by lung ultrasound: A protocol for a prospective, randomized controlled trial. PLoS One 2022; 17:e0273410. [PMID: 36084154 PMCID: PMC9462747 DOI: 10.1371/journal.pone.0273410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background The incidence of atelectasis is high in patients undergoing general anesthesia. This may cause oxygenation impairment and further contribute to postoperative pulmonary complications (PPCs). As important airway management devices for general anesthesia, few studies have compared the effects of laryngeal mask airway (LMA) and endotracheal tube (ETT) on atelectasis. Additionally, lung ultrasound has been increasingly used for bedside atelectasis diagnosis. For the above considerations, this trial is designed to compare the effects of LMA and ETT on atelectasis assessed by lung ultrasound scores, further providing more powerful clinical evidence for perioperative respiratory management of non-laparoscopic elective lower abdominal surgery under general anesthesia. Methods This is a prospective, single-center, single-blind, randomized controlled trial. From July 2021 to July 2022, 180 patients undergoing elective non-laparoscopic lower abdominal surgery under general anesthesia will be recruited and randomly divided into the ETT and LMA groups at a ratio of 1:1. The primary outcome is the total atelectasis LUS of 12 lung regions 15 min after the establishment of the artificial airway. The total atelectasis LUS at the end of surgery and 30 min after extubation, oxygenation index, postoperative airway complications, PPCs, and length of stay will be analyzed as secondary indicators. Trial registration ClinicalTrials.gov identifier: ChiCTR1900020818. Registered on January 20, 2019. Registered with the name of “Laryngeal mask airway versus endotracheal tube for atelectasis.” URL: https://www.chictr.org.cn/showproj.aspx?proj=35143.
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Garcia VP, Mattos JD, Mentzinger J, Leite PEC, Rocha HNM, Campos MO, Rocha MP, Mansur DE, Secher NH, Nóbrega ACL, Fernandes IA, Rocha NG. Short isocapnic hyperoxia affects indices of vascular remodeling and intercellular adhesion molecules in healthy men. Braz J Med Biol Res 2022; 55:e12110. [PMID: 35703682 PMCID: PMC9200048 DOI: 10.1590/1414-431x2022e12110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/11/2022] [Indexed: 11/22/2022] Open
Abstract
In preparation for tracheal intubation during induction of anesthesia, the patient may be ventilated with 100% oxygen. To investigate the impact of acute isocapnic hyperoxia on endothelial activation and vascular remodeling, ten healthy young men (24±3 years) were exposed to 5-min normoxia (21% O2) and 10-min hyperoxia trials (100% O2). During hyperoxia, intercellular adhesion molecules (ICAM-1) (hyperoxia: 4.16±0.85 vs normoxia: 3.51±0.84 ng/mL, P=0.04) and tissue inhibitor matrix metalloproteinase 1 (TIMP-1) (hyperoxia: 8.40±3.84 vs normoxia: 5.73±2.15 pg/mL, P=0.04) increased, whereas matrix metalloproteinase (MMP-9) activity (hyperoxia: 0.53±0.11 vs normoxia: 0.68±0.18 A.U., P=0.03) decreased compared to the normoxia trial. We concluded that even short exposure to 100% oxygen may affect endothelial activation and vascular remodeling.
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Affiliation(s)
- V P Garcia
- Laboratório de Ciências do Exercício, Departamento de Fisiologia e Farmacologia, Universidade Federal Fluminense, Niterói, RJ, Brasil
| | - J D Mattos
- Laboratório de Ciências do Exercício, Departamento de Fisiologia e Farmacologia, Universidade Federal Fluminense, Niterói, RJ, Brasil
| | - J Mentzinger
- Laboratório de Ciências do Exercício, Departamento de Fisiologia e Farmacologia, Universidade Federal Fluminense, Niterói, RJ, Brasil
| | - P E C Leite
- Laboratório de Bioengenharia e Toxicologia in Vitro, Instituto Nacional de Qualidade e Tecnologia Metrológica, Duque de Caxias, RJ, Brasil
| | - H N M Rocha
- Laboratório de Ciências do Exercício, Departamento de Fisiologia e Farmacologia, Universidade Federal Fluminense, Niterói, RJ, Brasil
| | - M O Campos
- Laboratório de Ciências do Exercício, Departamento de Fisiologia e Farmacologia, Universidade Federal Fluminense, Niterói, RJ, Brasil
| | - M P Rocha
- Laboratório de Ciências do Exercício, Departamento de Fisiologia e Farmacologia, Universidade Federal Fluminense, Niterói, RJ, Brasil
| | - D E Mansur
- Laboratório de Ciências do Exercício, Departamento de Fisiologia e Farmacologia, Universidade Federal Fluminense, Niterói, RJ, Brasil
| | - N H Secher
- Department of Anesthesia, Rigshospitalet, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - A C L Nóbrega
- Laboratório de Ciências do Exercício, Departamento de Fisiologia e Farmacologia, Universidade Federal Fluminense, Niterói, RJ, Brasil
| | - I A Fernandes
- NeuroVASQ - Laboratório de Fisiologia Integrativa, Faculdade de Educação Física, Universidade de Brasília, Brasília, DF, Brasil
| | - N G Rocha
- Laboratório de Ciências do Exercício, Departamento de Fisiologia e Farmacologia, Universidade Federal Fluminense, Niterói, RJ, Brasil
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Machado ML, Soares JHN, Pypendop BH, Aguiar AJA, Braun C, Motta-Ribeiro GC, Jandre FC. Cardiovascular and Gas Exchange Effects of Individualized Positive End-Expiratory Pressures in Cats Anesthetized With Isoflurane. Front Vet Sci 2022; 9:865673. [PMID: 35601404 PMCID: PMC9114870 DOI: 10.3389/fvets.2022.865673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To compare the effects of four levels of end-expiratory pressure [zero (ZEEP) and three levels of positive end-expiratory pressure (PEEP)] on the cardiovascular system and gas exchange of cats anesthetized with isoflurane and mechanically ventilated for 3 h with a tidal volume of 10 ml/kg. Study Design Prospective, randomized, controlled trial. Animals Six healthy male neutered purpose-bred cats. Methods Anesthesia was induced with isoflurane and maintained at 1.3 minimum alveolar concentration. PEEP of maximal respiratory compliance (PEEPmaxCrs) was identified in a decremental PEEP titration, and cats were randomly ventilated for 3 h with one of the following end-expiratory pressures: ZEEP, PEEPmaxCrs minus 2 cmH2O (PEEPmaxCrs−2), PEEPmaxCrs, and PEEPmaxCrs plus 2 cmH2O (PEEPmaxCrs+2). Cardiovascular and gas exchange variables were recorded at 5, 30, 60, 120, and 180 min (T5 to T180, respectively) of ventilation and compared between and within ventilation treatments with mixed-model ANOVA followed by Dunnet's and Tukey's tests (normal distribution) or Friedman test followed by the Dunn's test (non-normal distribution). Significance to reject the null hypothesis was considered p < 0.05. Results Mean arterial pressure (MAP—mmHg) was lower in PEEPmaxCrs+2 [63 (49–69); median (range)] when compared to ZEEP [71 (67–113)] at T5 and stroke index (ml/beat/kg) was lower in PEEPmaxCrs+2 (0.70 ± 0.20; mean ± SD) than in ZEEP (0.90 ± 0.20) at T60. Cardiac index, oxygen delivery index (DO2I), systemic vascular resistance index, and shunt fraction were not significantly different between treatments. The ratio between arterial partial pressure and inspired concentration of oxygen (PaO2/FIO2) was lower in ZEEP than in the PEEP treatments at various time points. At T180, DO2I was higher when compared to T5 in PEEPmaxCrs. Dopamine was required to maintain MAP higher than 60 mmHg in one cat during PEEPmaxCrs and in three cats during PEEPmaxCrs+2. Conclusion In cats anesthetized with isoflurane and mechanically ventilated for 3 h, all levels of PEEP mildly improved gas exchange with no significant difference in DO2I when compared to ZEEP. The PEEP levels higher than PEEPmaxCrs−2 caused more cardiovascular depression, and dopamine was an effective treatment. A temporal increase in DO2I was observed in the cats ventilated with PEEPmaxCrs. The effects of these levels of PEEP on respiratory mechanics, ventilation-induced lung injury, as well as in obese and critically ill cats deserve future investigation for a better understanding of the clinical use of PEEP in this species.
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Affiliation(s)
- Marcela L. Machado
- William Pritchard Veterinary Medical Teaching Hospital, University of California, Davis, Davis, CA, United States
| | - Joao H. N. Soares
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
- *Correspondence: Joao H. N. Soares
| | - Bruno H. Pypendop
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Antonio J. A. Aguiar
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
- Departamento de Cirurgia e Anestesiologia Veterinária, Faculdade de Medicina Veterinária e Zootecnia, UNESP—Univ. Estadual Paulista, Botucatu, Brazil
| | - Christina Braun
- Anaesthesiology and Perioperative Intensive Care, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Gabriel C. Motta-Ribeiro
- Laboratory of Pulmonary and Cardiovascular Engineering, Biomedical Engineering Program/COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Frederico C. Jandre
- Laboratory of Pulmonary and Cardiovascular Engineering, Biomedical Engineering Program/COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Biomedical Instrumentation Laboratory, Biomedical Engineering Program/COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Ambrósio AM, Sanchez AF, Pereira MAA, Andrade FSRMD, Rodrigues RR, Vitorasso RDL, Moriya HT, Fantoni DT. Assessment of Regional Ventilation During Recruitment Maneuver by Electrical Impedance Tomography in Dogs. Front Vet Sci 2022; 8:815048. [PMID: 35237676 PMCID: PMC8882687 DOI: 10.3389/fvets.2021.815048] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 12/28/2021] [Indexed: 01/07/2023] Open
Abstract
Background During protective mechanical ventilation, electrical impedance tomography (EIT) is used to monitor alveolar recruitment maneuvers as well as the distribution of regional ventilation. This technique can infer atelectasis and lung overdistention during mechanical ventilation in anesthetized patients or in the ICU. Changes in lung tissue stretching are evaluated by monitoring the electrical impedance of lung tissue with each respiratory cycle. Objective This study aimed to evaluate the distribution of regional ventilation during recruitment maneuvers based on the variables obtained in pulmonary electrical impedance tomography during protective mechanical ventilation, focusing on better lung recruitment associated with less or no overdistention. Methods Prospective clinical study using seven adult client–owned healthy dogs, weighing 25 ± 6 kg, undergoing elective ovariohysterectomy or orchiectomy. The animals were anesthetized and ventilated in volume-controlled mode (7 ml.kg−1) with stepwise PEEP increases from 0 to 20 cmH2O in steps of 5 cmH2O every 5 min and then a stepwise decrease. EIT, respiratory mechanics, oxygenation, and hemodynamic variables were recorded for each PEEP step. Results The results show that the regional compliance of the dependent lung significantly increased in the PEEP 10 cmH2O decrease step when compared with baseline (p < 0.027), and for the nondependent lung, there was a decrease in compliance at PEEP 20 cmH2O (p = 0.039) compared with baseline. A higher level of PEEP was associated with a significant increase in silent space of the nondependent regions from the PEEP 10 cmH2O increase step (p = 0.048) until the PEEP 15 cmH2O (0.019) decrease step with the highest values at PEEP 20 cmH20 (p = 0.016), returning to baseline values thereafter. Silent space of the dependent regions did not show any significant changes. Drive pressure decreased significantly in the PEEP 10 and 5 cmH2O decrease steps (p = 0.032) accompanied by increased respiratory static compliance in the same PEEP step (p = 0.035 and 0.018, respectively). Conclusions The regional ventilation distribution assessed by EIT showed that the best PEEP value for recruitment maintenance, capable of decreasing areas of pulmonary atelectasis in dependent regions promoting less overinflation in nondependent areas, was from 10 to 5 cmH2O decreased steps.
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Affiliation(s)
- Aline Magalhães Ambrósio
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
- *Correspondence: Aline Magalhães Ambrósio
| | - Ana Flávia Sanchez
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Marco Aurélio Amador Pereira
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | | | - Renata Ramos Rodrigues
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Renato de Lima Vitorasso
- Laboratory of Biomedical Engineering, Escola Politecnica, University of São Paulo, São Paulo, Brazil
| | - Henrique Takachi Moriya
- Laboratory of Biomedical Engineering, Escola Politecnica, University of São Paulo, São Paulo, Brazil
| | - Denise Tabacchi Fantoni
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
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Liang Y, Wu Z, Wei Y, Ding Q, Zilberman M, Tao K, Xie X, Wu J. Self-Healing, Self-Adhesive and Stable Organohydrogel-Based Stretchable Oxygen Sensor with High Performance at Room Temperature. NANO-MICRO LETTERS 2022; 14:52. [PMID: 35092489 PMCID: PMC8800976 DOI: 10.1007/s40820-021-00787-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/07/2021] [Indexed: 05/12/2023]
Abstract
With the advent of the 5G era and the rise of the Internet of Things, various sensors have received unprecedented attention, especially wearable and stretchable sensors in the healthcare field. Here, a stretchable, self-healable, self-adhesive, and room-temperature oxygen sensor with excellent repeatability, a full concentration detection range (0-100%), low theoretical limit of detection (5.7 ppm), high sensitivity (0.2%/ppm), good linearity, excellent temperature, and humidity tolerances is fabricated by using polyacrylamide-chitosan (PAM-CS) double network (DN) organohydrogel as a novel transducing material. The PAM-CS DN organohydrogel is transformed from the PAM-CS composite hydrogel using a facile soaking and solvent replacement strategy. Compared with the pristine hydrogel, the DN organohydrogel displays greatly enhanced mechanical strength, moisture retention, freezing resistance, and sensitivity to oxygen. Notably, applying the tensile strain improves both the sensitivity and response speed of the organohydrogel-based oxygen sensor. Furthermore, the response to the same concentration of oxygen before and after self-healing is basically the same. Importantly, we propose an electrochemical reaction mechanism to explain the positive current shift of the oxygen sensor and corroborate this sensing mechanism through rationally designed experiments. The organohydrogel oxygen sensor is used to monitor human respiration in real-time, verifying the feasibility of its practical application. This work provides ideas for fabricating more stretchable, self-healable, self-adhesive, and high-performance gas sensors using ion-conducting organohydrogels.
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Affiliation(s)
- Yuning Liang
- State Key Laboratory of Optoelectronic Materials and Technologies and the Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510275, People's Republic of China
| | - Zixuan Wu
- State Key Laboratory of Optoelectronic Materials and Technologies and the Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510275, People's Republic of China
| | - Yaoming Wei
- State Key Laboratory of Optoelectronic Materials and Technologies and the Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510275, People's Republic of China
| | - Qiongling Ding
- State Key Laboratory of Optoelectronic Materials and Technologies and the Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510275, People's Republic of China
| | - Meital Zilberman
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, 69978, Tel Aviv, Israel
| | - Kai Tao
- Ministry of Education Key Laboratory of Micro and Nano Systems for Aerospace, Northwestern Polytechnical University, Xi'an, 710072, People's Republic of China
| | - Xi Xie
- State Key Laboratory of Optoelectronic Materials and Technologies and the Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510275, People's Republic of China
| | - Jin Wu
- State Key Laboratory of Optoelectronic Materials and Technologies and the Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510275, People's Republic of China.
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10
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Singer M, Young PJ, Laffey JG, Asfar P, Taccone FS, Skrifvars MB, Meyhoff CS, Radermacher P. Dangers of hyperoxia. Crit Care 2021; 25:440. [PMID: 34924022 PMCID: PMC8686263 DOI: 10.1186/s13054-021-03815-y] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/04/2021] [Indexed: 01/27/2023] Open
Abstract
Oxygen (O2) toxicity remains a concern, particularly to the lung. This is mainly related to excessive production of reactive oxygen species (ROS). Supplemental O2, i.e. inspiratory O2 concentrations (FIO2) > 0.21 may cause hyperoxaemia (i.e. arterial (a) PO2 > 100 mmHg) and, subsequently, hyperoxia (increased tissue O2 concentration), thereby enhancing ROS formation. Here, we review the pathophysiology of O2 toxicity and the potential harms of supplemental O2 in various ICU conditions. The current evidence base suggests that PaO2 > 300 mmHg (40 kPa) should be avoided, but it remains uncertain whether there is an "optimal level" which may vary for given clinical conditions. Since even moderately supra-physiological PaO2 may be associated with deleterious side effects, it seems advisable at present to titrate O2 to maintain PaO2 within the normal range, avoiding both hypoxaemia and excess hyperoxaemia.
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Affiliation(s)
- Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK
| | - Paul J Young
- Medical Research Institute of New Zealand, and Intensive Care Unit, Wellington Hospital, Wellington, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Department of Critical Care Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - John G Laffey
- Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, and School of Medicine, National University of Ireland, Galway, Ireland
| | - Pierre Asfar
- Département de Médecine Intensive - Réanimation Et Médecine Hyperbare, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Fabio Silvio Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Christian S Meyhoff
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Radermacher
- Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum, Helmholtzstrasse 8-1, 89081, Ulm, Germany.
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11
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Colak YZ, Toprak HI. Feasibility, safety, and economic consequences of using minimal flow anaesthesia by Maquet FLOW-i equipped with automated gas control. Sci Rep 2021; 11:20074. [PMID: 34625647 PMCID: PMC8501136 DOI: 10.1038/s41598-021-99648-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 09/27/2021] [Indexed: 11/10/2022] Open
Abstract
Low fresh gas flow rates are recommended because of their benefits, however, its use is limited due to associated risks. The main purpose of this study was to investigate whether 300 mL of fresh gas flow that practised with automated gas control mode is applicable and safe. The second aim is to show that automated mode can provide economic benefits. Sixty hepatectomy cases who suitable criterias were included to cohort study in three groups as prospective, sequential, observational. An operating room were allocated only for this study. 300 mL fresh gas flow with automated mode (groupA3), 600 mL fresh gas flow with automated mode (groupA6) and, 600 mL fresh gas flow with manually (groupM6) was applied. Patients’ respiratory, hemodynamic parameters (safety), number of setting changes, O2 concentration in the flowmeter that maintained FiO2:0.4 during the low flow anaesthesia (feasibility) and comsumption data of anaesthetic agent and CO2 absorber (economical) were collected and compared. p < 0.05 was accepted as statistical significance level. No significant differences were detected between the groups in terms of demographic data and duration of operation. Safety datas (hemodynamic, respiratory, and tissue perfusion parameters) were within normal limits in all patients. O2 concentration in the flowmeter that maintained FiO2:0.4 was statistically higher in groupA3 (92%) than other groups (p < 0.001) but it was still within applicable limits (below the 100%). Number of setting changes was statistically higher in groupM6 than other groups (p < 0.001). The anaesthetic agent consumption was statistically less in groupA3 (p = 0.018). We performed fresh gas flow of 300 mL by automated mode without deviating from the safety limits and reduced the consumption of anaesthetic agent. We were able to maintain FiO2:0.4 in hepatectomies without much setting changes, and we think that the automated mode is better in terms of ease of practise.
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Affiliation(s)
- Yusuf Z Colak
- Department of Anaesthesiology and Reanimation, Medical Faculty, İnönü University, Malatya, 44280, Turkey.
| | - Hüseyin I Toprak
- Department of Anaesthesiology and Reanimation, Medical Faculty, İnönü University, Malatya, 44280, Turkey
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12
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The Effect of Balloon-Blowing Exercise on Postoperative Pulmonary Functions in Patients Undergoing Total Hip Arthroplasty. Orthop Nurs 2021; 40:182-188. [PMID: 34004618 DOI: 10.1097/nor.0000000000000758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
General anesthesia, prolonged immobilization, and pain may adversely affect pulmonary function in patients undergoing prosthetic surgery. The aim of this study was to evaluate the effect of balloon-blowing exercises on pulmonary functions in patients undergoing total hip arthroplasty. The patients in the experimental group performed three sets of balloon-blowing exercises in the morning, at noon, and in the evening on the first to third days postoperatively. The increase in forced vital capacity (FVC) values between the control and experimental groups in the postoperative period was statistically significant (p < .001), in favor of the experimental group. The increase in forced expiratory volume during the first second (FEV1)/FVC ratio was found to be significantly higher in the experimental group than in the control group (p < .001). Patients who performed balloon-blowing exercises increased their FVC and FEV1/FVC ratio.
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13
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Svensson-Raskh A, Schandl AR, Ståhle A, Nygren-Bonnier M, Fagevik Olsén M. Mobilization Started Within 2 Hours After Abdominal Surgery Improves Peripheral and Arterial Oxygenation: A Single-Center Randomized Controlled Trial. Phys Ther 2021; 101:6178886. [PMID: 33742678 PMCID: PMC8136304 DOI: 10.1093/ptj/pzab094] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/09/2020] [Accepted: 02/17/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim of this study was to investigate if mobilization out of bed, within 2 hours after abdominal surgery, improved participants' respiratory function and whether breathing exercises had an additional positive effect. METHODS Participants were 214 consecutively recruited patients who underwent elective open or robot-assisted laparoscopic gynecological, urological, or endocrinological abdominal surgery with an anesthetic duration of >2 hours. They were recruited to a randomized controlled trial. Immediately after surgery, patients were randomly assigned to 1 of 3 groups: mobilization (to sit in a chair) and standardized breathing exercises (n = 73), mobilization (to sit in a chair) only (n = 76), or control (n = 65). The interventions started within 2 hours after arrival at the postoperative recovery unit and continued for a maximum of 6 hours. The primary outcomes were differences in peripheral oxygen saturation (SpO2, as a percentage) and arterial oxygen pressure (PaO2, measured in kilopascals) between the groups. Secondary outcomes were arterial carbon dioxide pressure, spirometry, respiratory insufficiency, pneumonia, and length of stay. RESULTS Based on intention-to-treat analysis (n = 214), patients who received mobilization and breathing exercises had significantly improved SpO2 (mean difference [MD] = 2.5%; 95% CI = 0.4 to 4.6) and PaO2 (MD = 1.40 kPa; 95% CI = 0.64 to 2.17) compared with the controls. For mobilization only, there was an increase in PaO2 (MD = 0.97 kPa; 95% CI = 0.20 to 1.74) compared with the controls. In the per-protocol analysis (n = 201), there were significant improvements in SpO2 and PaO2 for both groups receiving mobilization compared with the controls. Secondary outcome measures did not differ between groups. CONCLUSION Mobilization out of bed, with or without breathing exercises, within 2 hours after elective abdominal surgery improved SpO2 and PaO2. IMPACT The respiratory effect of mobilization (out of bed) immediately after surgery has not been thoroughly evaluated in the literature. This study shows that mobilization out of bed following elective abdominal surgery can improve SpO2 and PaO2. LAY SUMMARY Mobilization within 2 hours after elective abdominal surgery, with or without breathing exercises, can improve patients' respiratory function.
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Affiliation(s)
- Anna Svensson-Raskh
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden,Women’s Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden,Address all correspondence to Ms Svensson-Raskh at:
| | - Anna Regina Schandl
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden,Department of Anesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Agneta Ståhle
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Malin Nygren-Bonnier
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden,Women’s Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Monika Fagevik Olsén
- Department of Neuroscience and Physiology, Division of Health & Rehabilitation/Physical Therapy, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden,Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
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14
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Colak YZ, Toprak HI. Feasibility, safety, and economic consequences of using low flow anesthesia according to body weight. J Anesth 2020; 34:537-542. [PMID: 32363423 DOI: 10.1007/s00540-020-02782-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/18/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Low flow anesthesia (LFA) provides a saving up to 75% and improves the dynamics of inhaled anesthesia gas, increases mucociliary clearance, maintains body temperature, and reduces water loss. LFA has been recommended for anesthesiologists in recent years to avoid high fresh gas flow (FGF). However, LFA use is limited due to associated risks. The main purpose of this study was to investigate whether LFA according to body weight, which is the main determinant of oxygen requirement, is feasible and safe in the normoxia range. The second aim was to show that this method can provide economic benefit. METHODS Eighty donor hepatectomy cases were included to study in two groups as prospective, observational. A surgery room and a team were allocated only for this study. Considering the oxygen requirement (approximately 3-3.5 mL/kg/min), for the first 40 cases, 10 mL/kg (group 10) FGF was applied; for the second 40 cases, 20 mL/kg (group 20) was applied. Desflurane (Suprane©) was used as an inhalation agent, and analgesia was achieved with remifentanil infusion. Patients' demographic, respiratory, hemodynamic, and tissue perfusion parameters (SpO2 and NIRS), and comsumption data (anesthetic agent and CO2 absorbent) were collected and compared. RESULTS No significant differences were detected between the groups in terms of demographic data, duration of surgery, and hemodynamic, respiratory, and tissue perfusion parameters. These parameters were within normal limits in all patients at all times. The maximum O2 concentration in the FGF that maintained FiO2:0.4 and provided adequate oxygenation during the LFA was 61% (min 56%; max 67%) in group 10, and 47% (min 43%; max 51%) in group 20. The hourly anesthetic agent consumption was significantly different in group 10 than in group 20 (12.4 ± 4 mL vs. 21.5 ± 8 mL/h, respectively (p < 0.001). CONCLUSIONS We performed 10 mL/kg FGF speed without deviating from the safety limits to be FiO2:0.4 in donor hepatectomies, reducing the total costs 38% compared with 20 mL/kg FGF.
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Affiliation(s)
- Yusuf Z Colak
- Department of Anesthesiology, Medical Faculty, İnönü University, 44280, Malatya, Turkey.
| | - Hüseyin I Toprak
- Department of Anesthesiology, Medical Faculty, İnönü University, 44280, Malatya, Turkey
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15
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Pitter SET, Kehlet H, Hansen CP, Bundgaard‐Nielsen M, Storkholm J, Aasvang EK. Persistent severe post-operative hypotension after pancreaticoduodenectomy is related to increased inflammatory response. Acta Anaesthesiol Scand 2020; 64:455-463. [PMID: 31828772 DOI: 10.1111/aas.13522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/30/2019] [Accepted: 11/24/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hypotension during major surgery is frequent, resulting in increased need for observation in the post-anaesthesia care unit and treatment including vasopressors and fluids. However, although severe hypotension in the immediate post-operative recovery phase after major surgery is suggested to be related to increased morbidity and mortality, the underlying risk factors are not well described, hindering advancements in prevention and treatment. METHODS We performed a retrospective study assessing factors (age, gender, body-mass index, cardiac co-morbidity, haemoglobin, absolute and increase in c-reactive protein on the first post-operative day, bleeding, fluid balance at the end of surgery and the first post-operative day) related to severe persistent hypotension (SPH) (SPH: need for noradrenaline to maintain a mean arterial blood pressure (MAP) >65.0 mm Hg on the morning after surgery) and occurrence of other early (24 hours) complications. One hundred patients undergoing pancreaticoduodenectomy (PD) with pre-operative high-dose glucocorticoid and goal-directed fluid therapy were enrolled and perioperative data collected from anaesthetic and medical records. RESULTS Forty-five patients had SPH, who had a significantly higher increase in CRP levels the morning after surgery (median 50 mg L-1 vs 41 mg L-1 , SPH vs non-SPH, respectively, P = .028), and a significantly more positive fluid balance at discharge (median 1457 ml vs 1031 ml, respectively, P = .027) vs patients without SPH. CONCLUSIONS Severe persistent hypotension after PD was associated with significantly increased inflammatory response and increased need for fluids. Future studies should investigate the effect of further inflammatory control in PD to improve haemodynamics and morbidity.
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Affiliation(s)
- Sandra E. Taylor Pitter
- Department of Anaesthesiology Centre for Cancer and Organ Diseases Rigshospitalet, Copenhagen Denmark
- Section for Surgical Pathophysiology Juliane Marie Centre Rigshospitalet Copenhagen Denmark
| | - Henrik Kehlet
- Section for Surgical Pathophysiology Juliane Marie Centre Rigshospitalet Copenhagen Denmark
| | - Carsten P. Hansen
- Department of Surgery Centre for Cancer and Organ Diseases Rigshospitalet Copenhagen Denmark
| | - Morten Bundgaard‐Nielsen
- Department of Anaesthesiology Centre for Cancer and Organ Diseases Rigshospitalet, Copenhagen Denmark
| | - Jan Storkholm
- Department of Surgery Centre for Cancer and Organ Diseases Rigshospitalet Copenhagen Denmark
| | - Eske K. Aasvang
- Department of Anaesthesiology Centre for Cancer and Organ Diseases Rigshospitalet, Copenhagen Denmark
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16
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Burcharth J, Ohm Oreskov J, Falkenberg A, Schack A, Ekeloef S, Gögenur I. Respiratory function following major emergency abdominal surgery. J Perioper Pract 2020; 30:389-394. [PMID: 32096439 DOI: 10.1177/1750458919888818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to evaluate the timewise postoperative respiratory function measured by spirometry and peak flow during the first postoperative week after major emergency abdominal surgery. Patients were tested daily with forced expiratory volume (FEV) and peak flow (PEF) from postoperative day (POD) 1 through to POD7. FEV1, FEV6, FEV1/FEV6 ratio and PEF were analysed by unadjusted linear regression with 95% confidence interval (CI) on mean values for each postoperative day. A total of 35 consecutive patients were included in the study. The FEV at 1 second was 51% of predicted at POD1, which increased to 67% at POD7 (p = 0.005), whereas FEV6 was 55% of predicted at POD1, which increased to 70% at POD7 (p = .008). Respiratory function was not significantly correlated to synchronous pain scores. In conclusion, respiratory function following major emergency abdominal surgery was reduced throughout the first postoperative week irrespective of pain scores.
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Affiliation(s)
- Jakob Burcharth
- Department of Surgery, Center for Surgical Science (CSS), Zealand University Hospital & University of Copenhagen, Denmark
| | - Jakob Ohm Oreskov
- Department of Surgery, Center for Surgical Science (CSS), Zealand University Hospital & University of Copenhagen, Denmark
| | - Andreas Falkenberg
- Department of Surgery, Center for Surgical Science (CSS), Zealand University Hospital & University of Copenhagen, Denmark
| | - Anders Schack
- Department of Surgery, Center for Surgical Science (CSS), Zealand University Hospital & University of Copenhagen, Denmark
| | - Sarah Ekeloef
- Department of Surgery, Center for Surgical Science (CSS), Zealand University Hospital & University of Copenhagen, Denmark
| | - Ismail Gögenur
- Department of Surgery, Center for Surgical Science (CSS), Zealand University Hospital & University of Copenhagen, Denmark
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17
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Généreux V, Chassé M, Girard F, Massicotte N, Chartrand-Lefebvre C, Girard M. Effects of positive end-expiratory pressure/recruitment manoeuvres compared with zero end-expiratory pressure on atelectasis during open gynaecological surgery as assessed by ultrasonography: a randomised controlled trial. Br J Anaesth 2020; 124:101-109. [DOI: 10.1016/j.bja.2019.09.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 12/22/2022] Open
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18
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Oguz A, Akcil EF, Tunali Y, Vehid H, Dilmen OK. Effects of propofol, desflurane, and sevoflurane on respiratory functions following endoscopic endonasal transsphenoidal pituitary surgery: a prospective randomized study. Korean J Anesthesiol 2019; 72:583-591. [PMID: 31602965 PMCID: PMC6900426 DOI: 10.4097/kja.19336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/09/2019] [Indexed: 12/11/2022] Open
Abstract
Background General anesthesia with intravenous or inhalation anesthetics reduces respiratory functions. We investigated the effects of propofol, desflurane, and sevoflurane on postoperative respiratory function tests. Methods This single-center randomized controlled study was performed in a university hospital from October 2015 to February 2017. Ninety patients scheduled for endoscopic endonasal transsphenoidal pituitary surgery were randomly categorized into either of these three groups: propofol (n = 30, the Group TIVA), desflurane (n = 30, the Group D) or sevoflurane (n = 30, the Group S). We analyzed the patients before, after, and 24 h following surgery, to identify the following parameters: forced expiratory volume in 1 second (FEV1) %, forced vital capacity (FVC) %, FEV1/FVC, and arterial blood gases (ABG). Furthermore, we also recorded the intraoperative dynamic lung compliance and airway resistance values. Results We did not find any significant differences in FEV1 values (primary outcome) among the groups (P = 0.336). There was a remarkable reduction in the FEV1 and FVC values in all groups postoperatively relative to the baseline (P < 0.001). The FVC, FEV1/FVC, ABG analysis, compliance, and airway resistance were similar among the groups. Intraoperative dynamic compliance values were lower at the 1st and 2nd hours than those immediately after intubation (P < 0.001). Conclusions We demonstrated that propofol, desflurane, and sevoflurane reduced FEV1 and FVC values postoperatively, without any significant differences among the drugs.
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Affiliation(s)
- Abdulvahap Oguz
- Department of Anesthesiology and Intensive Care, Cerrahpasa School of Medicine, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Eren Fatma Akcil
- Department of Anesthesiology and Intensive Care, Cerrahpasa School of Medicine, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Yusuf Tunali
- Department of Anesthesiology and Intensive Care, Cerrahpasa School of Medicine, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Hayriye Vehid
- Department of Biostatistics, Cerrahpasa School of Medicine, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Ozlem Korkmaz Dilmen
- Department of Anesthesiology and Intensive Care, Cerrahpasa School of Medicine, University of Istanbul-Cerrahpasa, Istanbul, Turkey
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19
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Motta-Ribeiro GC, Hashimoto S, Winkler T, Baron RM, Grogg K, Paula LFSC, Santos A, Zeng C, Hibbert K, Harris RS, Bajwa E, Vidal Melo MF. Deterioration of Regional Lung Strain and Inflammation during Early Lung Injury. Am J Respir Crit Care Med 2019; 198:891-902. [PMID: 29787304 DOI: 10.1164/rccm.201710-2038oc] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
RATIONALE The contribution of aeration heterogeneity to lung injury during early mechanical ventilation of uninjured lungs is unknown. OBJECTIVES To test the hypotheses that a strategy consistent with clinical practice does not protect from worsening in lung strains during the first 24 hours of ventilation of initially normal lungs exposed to mild systemic endotoxemia in supine versus prone position, and that local neutrophilic inflammation is associated with local strain and blood volume at global strains below a proposed injurious threshold. METHODS Voxel-level aeration and tidal strain were assessed by computed tomography in sheep ventilated with low Vt and positive end-expiratory pressure while receiving intravenous endotoxin. Regional inflammation and blood volume were estimated from 2-deoxy-2-[(18)F]fluoro-d-glucose (18F-FDG) positron emission tomography. MEASUREMENTS AND MAIN RESULTS Spatial heterogeneity of aeration and strain increased only in supine lungs (P < 0.001), with higher strains and atelectasis than prone at 24 hours. Absolute strains were lower than those considered globally injurious. Strains redistributed to higher aeration areas as lung injury progressed in supine lungs. At 24 hours, tissue-normalized 18F-FDG uptake increased more in atelectatic and moderately high-aeration regions (>70%) than in normally aerated regions (P < 0.01), with differential mechanistically relevant regional gene expression. 18F-FDG phosphorylation rate was associated with strain and blood volume. Imaging findings were confirmed in ventilated patients with sepsis. CONCLUSIONS Mechanical ventilation consistent with clinical practice did not generate excessive regional strain in heterogeneously aerated supine lungs. However, it allowed worsening of spatial strain distribution in these lungs, associated with increased inflammation. Our results support the implementation of early aeration homogenization in normal lungs.
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Affiliation(s)
- Gabriel C Motta-Ribeiro
- 1 Department of Anesthesia, Critical Care and Pain Medicine.,2 Biomedical Engineering Program, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Soshi Hashimoto
- 1 Department of Anesthesia, Critical Care and Pain Medicine.,3 Department of Anesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, Kyoto, Japan; and
| | - Tilo Winkler
- 1 Department of Anesthesia, Critical Care and Pain Medicine
| | - Rebecca M Baron
- 4 Department of Medicine (Pulmonary and Critical Care), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Arnoldo Santos
- 1 Department of Anesthesia, Critical Care and Pain Medicine.,6 CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Congli Zeng
- 1 Department of Anesthesia, Critical Care and Pain Medicine
| | - Kathryn Hibbert
- 7 Department of Medicine (Pulmonary and Critical Care), Massachusetts General Hospital, and
| | - Robert S Harris
- 7 Department of Medicine (Pulmonary and Critical Care), Massachusetts General Hospital, and
| | - Ednan Bajwa
- 7 Department of Medicine (Pulmonary and Critical Care), Massachusetts General Hospital, and
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20
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Effects of lung protective ventilation on postoperative respiratory parameters in patients undergoing robot-assisted radical prostatectomy. J Robot Surg 2019; 14:509-516. [PMID: 31506877 DOI: 10.1007/s11701-019-01016-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/22/2019] [Indexed: 02/02/2023]
Abstract
To investigate the effects of lung protective ventilation (LPV) compared to conventional ventilation (CV) on postoperative respiratory parameters in patients undergoing robot-assisted radical prostatectomy (RARP). In total, 24 patients undergoing RARP were randomized to two groups receiving either LPV with a tidal volume of 6 ml/IBW with a positive end-expiratory pressure (PEEP) of 10 cm H2O (intervention) or CV with a tidal volume of 10 ml/IBW with a PEEP of 4 cmH2O (control). Primary endpoint was PaO2 2 h postoperatively after 10 min of spontaneous respiration of atmospheric air. Forced expiratory volume during the first second (FEV1), forced vital capacity (FVC), diffusion capacity (DLCO), and plasma interleukin-6 (IL-6) was measured before and after the surgery. Pulmonary complications were registered within the first year after surgery. All patients completed the study. No difference was found in PaO2 between LPV and CV. However, 4 patients in the LPV group had a decrease in saturation below 90% during the 10 min of spontaneous respiration of atmospheric air compared to none in the CV group. FEV1, FVC, and DLCO were similar when comparing the two groups at all timepoints and no patients in either of the groups had pulmonary complications during the first postoperative year. IL-6 levels increased during surgery in both groups, but were not significantly different between the two groups. We found no evidence of lung protective effects of LPV compared to CV estimated by pulmonary function tests, IL-6 levels and postoperative complications in patients undergoing RARP. Surprisingly, only patients in the LPV group and none in the CV group had a decline in saturation below 90% during the 10 min of breathing atmospheric air.
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21
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Fjerbaek A, Westerdahl E, Andreasen JJ, Thomsen LP, Brocki BC. Change of position from a supine to a sitting position increases pulmonary function early after cardiac surgery. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1617778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Annette Fjerbaek
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
| | - Elisabeth Westerdahl
- Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jan J Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lars P. Thomsen
- Faculty of Medicine and Health, Respiratory and Critical Care Group (rcare), Aalborg University, Aalborg, Denmark
| | - Barbara C. Brocki
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
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22
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Koh JC, Hong JH, Kweon TD, Park JY, Ko E, Kim JY. Relationship between PaO2/FiO2 and number of regions with B-line on transthoracic lung ultrasound: a prospective, observational study. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.2.187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jae Chul Koh
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jung Hwa Hong
- Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Tae Dong Kweon
- Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Yeon Park
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Eunji Ko
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ji Young Kim
- Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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23
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Staehr-Rye AK, Meyhoff CS, Scheffenbichler FT, Vidal Melo MF, Gätke MR, Walsh JL, Ladha KS, Grabitz SD, Nikolov MI, Kurth T, Rasmussen LS, Eikermann M. High intraoperative inspiratory oxygen fraction and risk of major respiratory complications. Br J Anaesth 2018; 119:140-149. [PMID: 28974067 DOI: 10.1093/bja/aex128] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 11/14/2022] Open
Abstract
Background High inspiratory oxygen fraction ( FIO2 ) may improve tissue oxygenation but also impair pulmonary function. We aimed to assess whether the use of high intraoperative FIO2 increases the risk of major respiratory complications. Methods We studied patients undergoing non-cardiothoracic surgery involving mechanical ventilation in this hospital-based registry study. The cases were divided into five groups based on the median FIO2 between intubation and extubation. The primary outcome was a composite of major respiratory complications (re-intubation, respiratory failure, pulmonary oedema, and pneumonia) developed within 7 days after surgery. Secondary outcomes included 30-day mortality. Several predefined covariates were included in a multivariate logistic regression model. Results The primary analysis included 73 922 cases, of whom 3035 (4.1%) developed a major respiratory complication within 7 days of surgery. For patients in the high- and low-oxygen groups, the median FIO2 was 0.79 [range 0.64-1.00] and 0.31 [0.16-0.34], respectively. Multivariate logistic regression analysis revealed that the median FIO2 was associated in a dose-dependent manner with increased risk of respiratory complications (adjusted odds ratio for high vs low FIO2 1.99, 95% confidence interval [1.72-2.31], P -value for trend <0.001). This finding was robust in a series of sensitivity analyses including adjustment for intraoperative oxygenation. High median FIO2 was also associated with 30-day mortality (odds ratio for high vs low FIO2 1.97, 95% confidence interval [1.30-2.99], P -value for trend <0.001). Conclusions In this analysis of administrative data on file, high intraoperative FIO2 was associated in a dose-dependent manner with major respiratory complications and with 30-day mortality. The effect remained stable in a sensitivity analysis controlled for oxygenation. Clinical trial registration NCT02399878.
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Affiliation(s)
- A K Staehr-Rye
- Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.,Department of Anaesthesiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - C S Meyhoff
- Department of Anaesthesiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark.,Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark
| | - F T Scheffenbichler
- Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - M F Vidal Melo
- Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - M R Gätke
- Department of Anaesthesiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - J L Walsh
- Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - K S Ladha
- Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - S D Grabitz
- Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - M I Nikolov
- Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - T Kurth
- Institute of Public Health, Charité Universitätzmedizin Berlin, Germany
| | - L S Rasmussen
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Denmark
| | - M Eikermann
- Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.,Klinik für Anaesthesie und Intensivmedizin, Universitaetsklinikum Essen, Essen, Germany
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Park J, Min JJ, Kim SJ, Ahn JH, Kim K, Lee JH, Park K, Chung IS. Effects of lowering inspiratory oxygen fraction during microvascular decompression on postoperative gas exchange: A pre-post study. PLoS One 2018; 13:e0206371. [PMID: 30427854 PMCID: PMC6235305 DOI: 10.1371/journal.pone.0206371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/11/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite many previous studies, the optimal oxygen fraction during general anesthesia remains controversial. This study aimed to evaluate the effects of lowering intraoperative fraction of inspired oxygen on postoperative gas exchange in patients undergoing microvascular decompression (MVD). METHODS We conducted a pre-post study to compare postoperative gas exchange with different intraoperative oxygen fractions. From April 2010 to June 2017, 1456 consecutive patients who underwent MVD were enrolled. Starting in January 2014, routine oxygen fraction was lowered from 1.0 to 0.3 during anesthetic induction/awakening and from 0.5 to 0.3 during anesthetic maintenance. Postoperative gas exchange, presented as the minimum value of PaO2/FIO2 ratio within 48 hours, were compared along with adverse events. RESULTS Among 1456 patients, 623 (42.8%) patients were stratified into group H (high FIO2) and 833 (57.2%) patients into group L (low FIO2). Intraoperative positive end-expiratory pressure was used in 126 (15.1%) patients in group H and 90 (14.4%) patients in group L (p = 0.77).The minimum value of PaO2/ FIO2 ratio within 48 hours after surgery was significantly greater in the group L (226.13 vs. 323.12; p < 0.001) without increasing any adverse events. CONCLUSION In patients undergoing MVD, lowering routine FIO2 and avoiding 100% O2 improved postoperative gas exchange.
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Affiliation(s)
- Jungchan Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Jin Min
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Jin Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Hee Ahn
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keoungah Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| | - Kwan Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ik Soo Chung
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Petersen C, Wetterslev J, Meyhoff CS. Perioperative hyperoxia and post-operative cardiac complications in adults undergoing non-cardiac surgery: Systematic review protocol. Acta Anaesthesiol Scand 2018; 62:1014-1019. [PMID: 29664117 DOI: 10.1111/aas.13123] [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: 12/11/2017] [Revised: 03/06/2018] [Accepted: 03/14/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Oxygen therapy is used liberally for all patients undergoing anaesthesia. Recent studies have raised concerns that it may not be without complications when arterial oxygen concentrations reach supranormal concentrations (hyperoxia). Studies of oxygen therapy have raised concerns that the risk of myocardial injury and infarction is elevated in patients with hyperoxia due to vasoconstriction and formation of reactive oxygen species. Due to lack of symptoms or silent ischaemia, post-operative myocardial injury may be missed clinically. In some studies, perioperative hyperoxia has been linked to increased long-term mortality, but cardiac complications are sparsely evaluated. The aim of this review is to summarize current evidence to assess the risk and benefits of perioperative hyperoxia on post-operative cardiac complications. METHODS This systematic review will include meta-analyses and Trial Sequential Analyses. We will include randomized clinical trials with patients undergoing non-cardiac surgery if the allocation separates patients into a target of either higher (above 0.60) or lower (below 0.40) inspired oxygen fraction. To minimize the risk of systematic error, we will assess the risk of bias of the included trials using the Cochrane Risk of Bias Tool. The overall quality of evidence for each outcome will be assessed with the Grading of Recommendation, Assessment, Development and Evaluation (GRADE). DISCUSSION This systematic review will provide data on a severe, albeit rare, potential risk of oxygen therapy. We will do a trial sequential analysis to assess the robustness of results as well as help estimate the required patient size for future clinical trials.
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Affiliation(s)
- C Petersen
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J Wetterslev
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - C S Meyhoff
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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Soares JHN, Carvalho AR, Bergamini BC, Gress MAK, Jandre FC, Zin WA, Giannella-Neto A. Alveolar Tidal recruitment/derecruitment and Overdistension During Four Levels of End-Expiratory Pressure with Protective Tidal Volume During Anesthesia in a Murine Lung-Healthy Model. Lung 2018; 196:335-342. [DOI: 10.1007/s00408-018-0096-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/05/2018] [Indexed: 12/16/2022]
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Abstract
PURPOSE OF REVIEW This article provides the reader with recent findings on the pathophysiology of comorbidities in the obese, as well as evidence-based treatment options to deal with perioperative respiratory challenges. RECENT FINDINGS Our understanding of obesity-associated asthma, obstructive sleep apnea, and obesity hypoventilation syndrome is still expanding. Routine screening for obstructive sleep apnea using the STOP-Bang score might identify high-risk patients that benefit from perioperative continuous positive airway pressure and close postoperative monitoring. Measures to most effectively support respiratory function during induction of and emergence from anesthesia include optimal patient positioning and use of noninvasive positive pressure ventilation. Appropriate mechanical ventilation settings are under investigation, so that only the use of protective low tidal volumes could be currently recommended. A multimodal approach consisting of adjuvants, as well as regional anesthesia/analgesia techniques reduces the need for systemic opioids and related respiratory complications. SUMMARY Anesthesia of obese patients for nonbariatric surgical procedures requires knowledge of typical comorbidities and their respective treatment options. Apart from cardiovascular diseases associated with the metabolic syndrome, awareness of any pulmonary dysfunction is of paramount. A multimodal analgesia approach may be useful to reduce postoperative pulmonary complications.
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Maia LDA, Samary CS, Oliveira MV, Santos CL, Huhle R, Capelozzi VL, Morales MM, Schultz MJ, Abreu MG, Pelosi P, Silva PL, Rocco PRM. Impact of Different Ventilation Strategies on Driving Pressure, Mechanical Power, and Biological Markers During Open Abdominal Surgery in Rats. Anesth Analg 2017; 125:1364-1374. [DOI: 10.1213/ane.0000000000002348] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Gao S, Zhang Z, Brunelli A, Chen C, Chen C, Chen G, Chen H, Chen JS, Cassivi S, Chai Y, Downs JB, Fang W, Fu X, Garutti MI, He J, He J, Hu J, Huang Y, Jiang G, Jiang H, Jiang Z, Li D, Li G, Li H, Li Q, Li X, Li Y, Li Z, Liu CC, Liu D, Liu L, Liu Y, Ma H, Mao W, Mao Y, Mou J, Ng CSH, Petersen RH, Qiao G, Rocco G, Ruffini E, Tan L, Tan Q, Tong T, Wang H, Wang Q, Wang R, Wang S, Xie D, Xue Q, Xue T, Xu L, Xu S, Xu S, Yan T, Yu F, Yu Z, Zhang C, Zhang L, Zhang T, Zhang X, Zhao X, Zhao X, Zhi X, Zhou Q. The Society for Translational Medicine: clinical practice guidelines for mechanical ventilation management for patients undergoing lobectomy. J Thorac Dis 2017; 9:3246-3254. [PMID: 29221302 PMCID: PMC5708473 DOI: 10.21037/jtd.2017.08.166] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Patients undergoing lobectomy are at significantly increased risk of lung injury. One-lung ventilation is the most commonly used technique to maintain ventilation and oxygenation during the operation. It is a challenge to choose an appropriate mechanical ventilation strategy to minimize the lung injury and other adverse clinical outcomes. In order to understand the available evidence, a systematic review was conducted including the following topics: (I) protective ventilation (PV); (II) mode of mechanical ventilation [e.g., volume controlled (VCV) versus pressure controlled (PCV)]; (III) use of therapeutic hypercapnia; (IV) use of alveolar recruitment (open-lung) strategy; (V) pre-and post-operative application of positive end expiratory pressure (PEEP); (VI) Inspired Oxygen concentration; (VII) Non-intubated thoracoscopic lobectomy; and (VIII) adjuvant pharmacologic options. The recommendations of class II are non-intubated thoracoscopic lobectomy may be an alternative to conventional one-lung ventilation in selected patients. The recommendations of class IIa are: (I) Therapeutic hypercapnia to maintain a partial pressure of carbon dioxide at 50-70 mmHg is reasonable for patients undergoing pulmonary lobectomy with one-lung ventilation; (II) PV with a tidal volume of 6 mL/kg and PEEP of 5 cmH2O are reasonable methods, based on current evidence; (III) alveolar recruitment [open lung ventilation (OLV)] may be beneficial in patients undergoing lobectomy with one-lung ventilation; (IV) PCV is recommended over VCV for patients undergoing lung resection; (V) pre- and post-operative CPAP can improve short-term oxygenation in patients undergoing lobectomy with one-lung ventilation; (VI) controlled mechanical ventilation with I:E ratio of 1:1 is reasonable in patients undergoing one-lung ventilation; (VII) use of lowest inspired oxygen concentration to maintain satisfactory arterial oxygen saturation is reasonable based on physiologic principles; (VIII) Adjuvant drugs such as nebulized budesonide, intravenous sivelestat and ulinastatin are reasonable and can be used to attenuate inflammatory response.
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Affiliation(s)
- Shugeng Gao
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center, Beijing 100021, China
| | - Zhongheng Zhang
- Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | | | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai 200433, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fujian 350001, China
| | - Gang Chen
- Department of Thoracic Surgery, Guangdong General Hospital, Guangzhou 510080, China
| | | | - Jin-Shing Chen
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan
| | | | - Ying Chai
- Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou 310009, China
| | - John B. Downs
- Department of Anesthesiology and Critical Care Medicine, University of Florida, Gainesville, FL, USA
| | - Wentao Fang
- Shanghai Chest Hospital, Shanghai 200030, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Martínez I. Garutti
- Department of Anaesthesia and Postoperative Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510000, China
| | - Jie He
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center, Beijing 100021, China
| | - Jian Hu
- First Affiliated Hospital, Medical College of Zhejiang University, Hangzhou 310003, China
| | - Yunchao Huang
- Department of Thoracic Surgery, Yunnan Cancer Hospital, Kunming 650100, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai 200433, China
| | - Hongjing Jiang
- Department of Esophageal Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Zhongmin Jiang
- Department of Thoracic Surgery, Shandong Qianfoshan Hospital, Jinan 250014, China
| | - Danqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Beijing 100032, China
| | - Gaofeng Li
- Department of Thoracic Surgery, Yunnan Cancer Hospital, Kunming 650100, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Beijing 100049, China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Chengdu 610041, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital Fourth Military Medical University, Xi’an 710038, China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Zhijun Li
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Chia-Chuan Liu
- Division of Thoracic Surgery, Department of Surgery, Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Deruo Liu
- Department of Thoracic Surgery, China and Japan Friendship Hospital, Beijing 100029, China
| | - Lunxu Liu
- Department of Cardiovascular and Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yongyi Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shengyang 110042, China
| | - Haitao Ma
- Department of Thoracic Surgery, The First Hospital Affiliated to Soochow University, Suzhou 215000, China
| | - Weimin Mao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310000, China
| | - Yousheng Mao
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center, Beijing 100021, China
| | - Juwei Mou
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center, Beijing 100021, China
| | - Calvin Sze Hang Ng
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong, China
| | - René H. Petersen
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Guibin Qiao
- Department of Thoracic Surgery, Guangzhou General Hospital of Guangzhou Military Area Command, Guangzhou 510000, China
| | - Gaetano Rocco
- Department of Thoracic Surgery and Oncology, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Erico Ruffini
- Thoracic Surgery Unit, University of Torino, Torino, Italy
| | - Lijie Tan
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Qunyou Tan
- Department of Thoracic Surgery, Daping Hospital, Research Institute of Surgery Third Military Medical University, Chongqing 400042, China
| | - Tang Tong
- Department of Thoracic Surgery, Second Affiliated Hospital of Jilin University, Changchun 130041, China
| | - Haidong Wang
- Department of Thoracic Surgery, Southwest Hospital, Third Millitary Medical University, Chongqing 400038, China
| | - Qun Wang
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Ruwen Wang
- Department of Thoracic Surgery, Daping Hospital, Research Institute of Surgery Third Military Medical University, Chongqing 400042, China
| | - Shumin Wang
- Department of Thoracic Surgery, General Hospital of Shenyang Military Area, Shenyang 110015, China
| | - Deyao Xie
- Department of Cardiovascular and Thoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Qi Xue
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center, Beijing 100021, China
| | - Tao Xue
- Department of Thoracic Surgery, Zhongda Hospital Southeast University, Nanjing 210009, China
| | - Lin Xu
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing 210008, China
| | - Shidong Xu
- Department of Thoracic Surgery, Heilongjiang Cancer Hospital, Harbin 150049, China
| | - Songtao Xu
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Tiansheng Yan
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100083, China
| | - Fenglei Yu
- Department of Cardiovascular Surgery, Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Zhentao Yu
- Department of Esophageal Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Chunfang Zhang
- Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Lanjun Zhang
- Cancer Center, San Yat-sen University, Guangzhou 510060, China
| | - Tao Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China
| | - Xun Zhang
- Department of Thoracic Surgery, Tanjin Chest Hospital, Tianjin 300300, China
| | - Xiaojing Zhao
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200000, China
| | - Xuewei Zhao
- Department of Thoracic Surgery, Shanghai Changzheng Hospital, Shanghai 200000, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital of Capital University of Medical Sciences, Beijing 100053, China
| | - Qinghua Zhou
- Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shengyang 110042, China
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Scheeren TWL, Belda FJ, Perel A. The oxygen reserve index (ORI): a new tool to monitor oxygen therapy. J Clin Monit Comput 2017; 32:379-389. [PMID: 28791567 PMCID: PMC5943373 DOI: 10.1007/s10877-017-0049-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/17/2017] [Indexed: 12/19/2022]
Abstract
Supplemental oxygen is administered in the vast majority of patients in the perioperative setting and in the intensive care unit to prevent the potentially deleterious effects of hypoxia. On the other hand, the administration of high concentrations of oxygen may induce hyperoxia that may also be associated with significant complications. Oxygen therapy should therefore be precisely titrated and accurately monitored. Although pulse oximetry has become an indispensable monitoring technology to detect hypoxemia, its value in assessing the oxygenation status beyond the range of maximal arterial oxygen saturation (SpO2 ≥97%) is very limited. In this hyperoxic range, we need to rely on blood gas analysis, which is intermittent, invasive and sometimes delayed. The oxygen reserve index (ORI) is a new continuous non-invasive variable that is provided by the new generation of pulse oximeters that use multi-wavelength pulse co-oximetry. The ORI is a dimensionless index that reflects oxygenation in the moderate hyperoxic range (PaO2 100-200 mmHg). The ORI may provide an early alarm when oxygenation deteriorates well before any changes in SpO2 occur, may reflect the response to oxygen administration (e.g., pre-oxygenation), and may facilitate oxygen titration and prevent unintended hyperoxia. In this review we describe this new variable, summarize available data and preliminary experience, and discuss its potential clinical utilities in the perioperative and intensive care settings.
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Affiliation(s)
- T W L Scheeren
- Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands.
| | - F J Belda
- Department of Anesthesiology, Hospital Clínico Universitario, Valencia, Spain
| | - A Perel
- Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
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Sah HK, Akcil EF, Tunali Y, Vehid H, Dilmen OK. Efficacy of continuous positive airway pressure and incentive spirometry on respiratory functions during the postoperative period following supratentorial craniotomy: A prospective randomized controlled study. J Clin Anesth 2017; 42:31-35. [PMID: 28797752 DOI: 10.1016/j.jclinane.2017.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 07/26/2017] [Accepted: 08/03/2017] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE Volume controlled ventilation with low PEEP is used in neuro-anesthesia to provide constant PaCO2 levels and prevent raised intracranial pressure. Therefore, neurosurgery patients prone to atelectasis formation, however, we could not find any study that evaluates prevention of postoperative pulmonary complications in neurosurgery. DESIGN A prospective, randomized controlled study. SETTING Intensive care unit in a university hospital in Istanbul. PATIENTS Seventy-nine ASAI-II patients aged between 18 and 70years scheduled for elective supratentorial craniotomy were included in the study. INTERVENTIONS Patients randomized into 3 groups after surgery. The Group IS (n=20) was treated with incentive spirometry 5 times in 1min and 5min per hour, the Group CPAP (n=20) with continuous positive airway pressure 10 cmH2O pressure and 0.4 FiO2 via an oronasal mask 5min per hour, and the Group Control (n=20) 4L·min-1O2 via mask; all during the first 6h postoperatively. Respiratory functions tests and arterial blood gases analysis were performed before the induction of anesthesia (Baseline), 30min, 6h, 24h postoperatively. MAIN RESULTS The IS and CPAP applications have similar effects with respect to FVC values. The postoperative 30min FEV1 values were statistically significantly reduced compared to the Baseline in all groups (p<0.0001). FEV1 values were statistically significantly increased at the postoperative 24h compared to the postoperative 30min in the Groups IS and CPAP (p<0.0001). This increase, however, was not observed in the Group Control, and the postoperative 24h FEV1 values were statistically significantly lower in the Group Control compared to the Group IS (p=0.015). CONCLUSION Although this study is underpowered to detect differences in FEV1 values, the postoperative 24h FEV1 values were significantly higher in the IS group than the Control group and this difference was not observed between the CPAP and Control groups. It might be evaluate a favorable effect of IS in neurosurgery patients. But larger studies are needed to make a certain conclusion.
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Affiliation(s)
- Hulya Kahraman Sah
- University of Istanbul, Cerrahpasa School of Medicine, Department of Anesthesiology and Intensive Care, Turkey
| | - Eren Fatma Akcil
- University of Istanbul, Cerrahpasa School of Medicine, Department of Anesthesiology and Intensive Care, Turkey
| | - Yusuf Tunali
- University of Istanbul, Cerrahpasa School of Medicine, Department of Anesthesiology and Intensive Care, Turkey
| | - Hayriye Vehid
- University of Istanbul, Cerrahpasa School of Medicine, Department of Biostatistics, Turkey.
| | - Ozlem Korkmaz Dilmen
- University of Istanbul, Cerrahpasa School of Medicine, Department of Anesthesiology and Intensive Care, Turkey.
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Hedenstierna G. Optimum PEEP During Anesthesia and in Intensive Care is a Compromise but is Better than Nothing. Turk J Anaesthesiol Reanim 2016; 44:161-162. [PMID: 27909586 DOI: 10.5152/tjar.2016.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Göran Hedenstierna
- Hedenstierna Laboratory, Department of Medical Sciences, Clinical Physiology, Uppsala University Hospital, Sweden
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Pompilio CE, Pelosi P, Castro MG. The Bariatric Patient in the Intensive Care Unit: Pitfalls and Management. Curr Atheroscler Rep 2016; 18:55. [DOI: 10.1007/s11883-016-0606-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Singh PM, Borle A, Shah D, Sinha A, Makkar JK, Trikha A, Goudra BG. Optimizing Prophylactic CPAP in Patients Without Obstructive Sleep Apnoea for High-Risk Abdominal Surgeries: A Meta-regression Analysis. Lung 2016; 194:201-17. [DOI: 10.1007/s00408-016-9855-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 02/05/2016] [Indexed: 01/29/2023]
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Barbas CSV, Ísola AM, Farias AMDC, Cavalcanti AB, Gama AMC, Duarte ACM, Vianna A, Serpa Neto A, Bravim BDA, Pinheiro BDV, Mazza BF, de Carvalho CRR, Toufen Júnior C, David CMN, Taniguchi C, Mazza DDDS, Dragosavac D, Toledo DO, Costa EL, Caser EB, Silva E, Amorim FF, Saddy F, Galas FRBG, Silva GS, de Matos GFJ, Emmerich JC, Valiatti JLDS, Teles JMM, Victorino JA, Ferreira JC, Prodomo LPDV, Hajjar LA, Martins LC, Malbouisson LMS, Vargas MADO, Reis MAS, Amato MBP, Holanda MA, Park M, Jacomelli M, Tavares M, Damasceno MCP, Assunção MSC, Damasceno MPCD, Youssef NCM, Teixeira PJZ, Caruso P, Duarte PAD, Messeder O, Eid RC, Rodrigues RG, de Jesus RF, Kairalla RA, Justino S, Nemer SN, Romero SB, Amado VM. Brazilian recommendations of mechanical ventilation 2013. Part 2. Rev Bras Ter Intensiva 2016; 26:215-39. [PMID: 25295817 PMCID: PMC4188459 DOI: 10.5935/0103-507x.20140034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2013] [Indexed: 12/13/2022] Open
Abstract
Perspectives on invasive and noninvasive ventilatory support for critically ill
patients are evolving, as much evidence indicates that ventilation may have positive
effects on patient survival and the quality of the care provided in intensive care
units in Brazil. For those reasons, the Brazilian Association of Intensive Care
Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and
the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e
Tisiologia - SBPT), represented by the Mechanical Ventilation Committee
and the Commission of Intensive Therapy, respectively, decided to review the
literature and draft recommendations for mechanical ventilation with the goal of
creating a document for bedside guidance as to the best practices on mechanical
ventilation available to their members. The document was based on the available
evidence regarding 29 subtopics selected as the most relevant for the subject of
interest. The project was developed in several stages, during which the selected
topics were distributed among experts recommended by both societies with recent
publications on the subject of interest and/or significant teaching and research
activity in the field of mechanical ventilation in Brazil. The experts were divided
into pairs that were charged with performing a thorough review of the international
literature on each topic. All the experts met at the Forum on Mechanical Ventilation,
which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to
collaboratively draft the final text corresponding to each sub-topic, which was
presented to, appraised, discussed and approved in a plenary session that included
all 58 participants and aimed to create the final document.
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Affiliation(s)
- Carmen Sílvia Valente Barbas
- Corresponding author: Carmen Silvia Valente Barbas, Disicplina de
Pneumologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São
Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 44, Zip code - 05403-900 - São Paulo
(SP), Brazil, E-mail:
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Edmark L, Östberg E, Scheer H, Wallquist W, Hedenstierna G, Zetterström H. Preserved oxygenation in obese patients receiving protective ventilation during laparoscopic surgery: a randomized controlled study. Acta Anaesthesiol Scand 2016; 60:26-35. [PMID: 26235391 DOI: 10.1111/aas.12588] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 05/28/2015] [Accepted: 06/08/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Venous admixture from atelectasis and airway closure impedes oxygenation during general anaesthesia. We tested the hypothesis that continuous positive airway pressure (CPAP) during pre-oxygenation and reduced fraction of inspiratory oxygen (FIO2 ) during emergence from anaesthesia can improve oxygenation in patients with obesity undergoing laparoscopic surgery. METHODS In the intervention group (n = 20, median BMI 41.9), a CPAP of 10 cmH2 O was used during pre-oxygenation and induction of anaesthesia, but no CPAP was used in the control group (n = 20, median BMI 38.1). During anaesthesia, all patients were ventilated in volume-controlled mode with an FIO2 of 0.4 and a positive end-expiratory pressure (PEEP) of 10 cmH2 O. During emergence, before extubation, the control group was given an FIO2 of 1.0 and the intervention group was divided into two subgroups, which were given an FIO2 of 1.0 or 0.31. Oxygenation was assessed perioperatively by the estimated venous admixture (EVA). RESULTS The median EVA before pre-oxygenation was about 8% in both groups. During anaesthesia after intubation, the median EVA was 8.2% in the intervention vs. 13.2% in the control group (P = 0.048). After CO2 pneumoperitoneum, the median EVA was 8.4% in the intervention vs. 9.9% in the control group (P > 0.05). One hour post-operatively, oxygenation had deteriorated in patients given an FIO2 of 1.0 during emergence but not in patients given an FIO2 of 0.31. CONCLUSIONS A CPAP of 10 cmH2 O during pre-oxygenation and induction, followed by PEEP after intubation, seemed to preserve oxygenation during anaesthesia. Post-operative oxygenation depended on the FIO2 used during emergence.
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Affiliation(s)
- L. Edmark
- Department of Anaesthesiology and Intensive Care; Västmanland Hospital Västerås; Västerås Sweden
| | - E. Östberg
- Department of Anaesthesiology and Intensive Care; Västmanland Hospital Västerås; Västerås Sweden
| | - H. Scheer
- Department of Anaesthesiology and Intensive Care; Västmanland Hospital Västerås; Västerås Sweden
| | - W. Wallquist
- Department of Anaesthesiology and Intensive Care; Västmanland Hospital Västerås; Västerås Sweden
| | - G. Hedenstierna
- Department of Medical Sciences, Clinical Physiology; Uppsala University; Uppsala Sweden
| | - H. Zetterström
- Department of Surgical Sciences, Anaesthesiology and Critical Care Medicine; Uppsala University; Uppsala Sweden
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Rubin JM, Horowitz JC, Sisson TH, Kim K, Ortiz LA, Hamilton JD. Ultrasound Strain Measurements for Evaluating Local Pulmonary Ventilation. IEEE INTERNATIONAL ULTRASONICS SYMPOSIUM : [PROCEEDINGS]. IEEE INTERNATIONAL ULTRASONICS SYMPOSIUM 2015; 2015:10.1109/ULTSYM.2015.0181. [PMID: 26635917 PMCID: PMC4666290 DOI: 10.1109/ultsym.2015.0181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Local lung function is difficult to evaluate, because most lung function estimates are either global in nature, e.g. pulmonary function tests, or require equipment that cannot be used at a patient's bedside, such as computed tomograms. Yet, local function measurements would be highly desirable for many reasons. In a recent publication [1], we were able to track displacements of the lung surface during breathing. We have now extended these results to measuring lung strains during respiration as a means of assessing local lung ventilation. We studied two normal human volunteers and 12 mice with either normal lung function or experimentally induced pulmonary fibrosis. The difference in strains between the control, normal mice and those with pulmonary fibrosis was significant (p < 0.02), while the strains measured in the human volunteers closely matched linear strains predicted from the literature. Ultrasonography may be able to assess local lung ventilation.
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Affiliation(s)
| | | | | | - Kang Kim
- University of Pittsburgh, Pittsburgh, PA, USA
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Capnodynamic assessment of effective lung volume during cardiac output manipulations in a porcine model. J Clin Monit Comput 2015; 30:761-769. [PMID: 26377022 DOI: 10.1007/s10877-015-9767-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 09/09/2015] [Indexed: 10/23/2022]
Abstract
A capnodynamic calculation of effective pulmonary blood flow includes a lung volume factor (ELV) that has to be estimated to solve the mathematical equation. In previous studies ELV correlated to reference methods for functional residual capacity (FRC). The aim was to evaluate the stability of ELV during significant manipulations of cardiac output (CO) and assess the agreement for absolute values and trending capacity during PEEP changes at different lung conditions. Ten pigs were included. Alterations of alveolar carbon dioxide were induced by cyclic reoccurring inspiratory holds. The Sulphur hexafluoride technique for FRC measurements was used as reference. Cardiac output was altered by preload reduction and inotropic stimulation at PEEP 5 and 12 cmH2O both in normal lung conditions and after repeated lung lavages. ELV at baseline PEEP 5 was [mean (SD)], 810 (163) mL and decreased to 400 (42) mL after lavage. ELV was not significantly affected by CO alterations within the same PEEP level. In relation to FRC the overall bias (limits of agreement) was -35 (-271 to 201) mL, and percentage error 36 %. A small difference between ELV and FRC was seen at PEEP 5 cmH2O before lavage and at PEEP 12 cmH2O after lavage. ELV trending capability between PEEP steps, showed a concordance rate of 100 %. ELV was closely related to FRC and remained stable during significant changes in CO. The trending capability was excellent both before and after surfactant depletion.
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Hedenstierna G. Small Tidal Volumes, Positive End-expiratory Pressure, and Lung Recruitment Maneuvers during Anesthesia. Anesthesiology 2015; 123:501-3. [DOI: 10.1097/aln.0000000000000755] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Göran Hedenstierna
- From the Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala, Sweden
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Ziebart A, Garcia-Bardon A, Kamuf J, Thomas R, Liu T, Schad A, Duenges B, David M, Hartmann EK. Pulmonary effects of expiratory-assisted small-lumen ventilation during upper airway obstruction in pigs. Anaesthesia 2015; 70:1171-9. [PMID: 26179167 DOI: 10.1111/anae.13154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2015] [Indexed: 11/28/2022]
Abstract
Novel devices for small-lumen ventilation may enable effective inspiration and expiratory ventilation assistance despite airway obstruction. In this study, we investigated a porcine model of complete upper airway obstruction. After ethical approval, we randomly assigned 13 anaesthetised pigs either to small-lumen ventilation following airway obstruction (n = 8) for 30 min, or to volume-controlled ventilation (sham setting, n = 5). Small-lumen ventilation enabled adequate gas exchange over 30 min. One animal died as a result of a tension pneumothorax in this setting. Redistribution of ventilation from dorsal to central compartments and significant impairment of the distribution of ventilation/perfusion occurred. Histopathology demonstrated considerable lung injury, predominantly through differences in the dorsal dependent lung regions. Small-lumen ventilation maintained adequate gas exchange in a porcine airway obstruction model. The use of this technique for 30 min by inexperienced clinicians was associated with considerable end-expiratory collapse leading to lung injury, and may also carry the risk of severe injury.
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Affiliation(s)
- A Ziebart
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - A Garcia-Bardon
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - J Kamuf
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - R Thomas
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - T Liu
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - A Schad
- Institute of Pathology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - B Duenges
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - M David
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - E K Hartmann
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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Hedenstierna G, Edmark L, Perchiazzi G. Postoperative lung complications: have multicentre studies been of any help? Br J Anaesth 2015; 114:541-3. [DOI: 10.1093/bja/aeu343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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42
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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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43
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Miller DL, Dou C, Raghavendran K. Anesthetic techniques influence the induction of pulmonary capillary hemorrhage during diagnostic ultrasound scanning in rats. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:289-97. [PMID: 25614402 PMCID: PMC4361812 DOI: 10.7863/ultra.34.2.289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVES Pulmonary capillary hemorrhage can be induced by diagnostic ultrasound (US) during direct pulmonary US scanning in rats. The influence of specific anesthetic techniques on this bioeffect was examined. METHODS Ketamine plus xylazine has been used previously. In this study, the influence of intraperitoneal injections of ketamine and pentobarbital, inhalational isoflurane, and the supplemental use of xylazine with ketamine and isoflurane was tested. A diagnostic US machine with a 7.6-MHz linear array was used to image the right lung of anesthetized rats in a warmed water bath at different mechanical index (MI) settings. Pulmonary capillary hemorrhage was assessed by measuring comet tail artifacts in the image and by morphometry of the hemorrhagic areas on excised lungs. RESULTS Pulmonary capillary hemorrhage was greatest for pentobarbital, lower for inhalational isoflurane, and lowest for ketamine anesthesia, with occurrence thresholds at MIs of about 0.44, 0.8, and 0.8, respectively. Addition of xylazine produced a substantial increase in hemorrhage and a significant proportion of hemorrhage occurrence for ketamine at an MI of 0.7 (P < .01) and for isoflurane at an MI of 0.52 (P < .01). CONCLUSIONS Ketamine plus xylazine and pentobarbital yield lower thresholds than ketamine or isoflurane alone by nearly a factor of 2 in MI. These results suggest that the choice of the anesthetic agent substantially modifies the relative risks of pulmonary capillary hemorrhage from pulmonary US.
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Affiliation(s)
- Douglas L Miller
- Departments of Radiology (D.L.M., C.D.) and Surgery (K.R.), University of Michigan Health System, Ann Arbor, Michigan USA.
| | - Chunyan Dou
- Departments of Radiology (D.L.M., C.D.) and Surgery (K.R.), University of Michigan Health System, Ann Arbor, Michigan USA
| | - Krishnan Raghavendran
- Departments of Radiology (D.L.M., C.D.) and Surgery (K.R.), University of Michigan Health System, Ann Arbor, Michigan USA
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von Bormann B, Suksompong S, Weiler J, Zander R. Pure oxygen ventilation during general anaesthesia does not result in increased postoperative respiratory morbidity but decreases surgical site infection. An observational clinical study. PeerJ 2014; 2:e613. [PMID: 25320681 PMCID: PMC4194458 DOI: 10.7717/peerj.613] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 09/16/2014] [Indexed: 11/24/2022] Open
Abstract
Background. Pure oxygen ventilation during anaesthesia is debatable, as it may lead to development of atelectasis. Rationale of the study was to demonstrate the harmlessness of ventilation with pure oxygen. Methods. This is a single-centre, one-department observational trial. Prospectively collected routine-data of 76,784 patients undergoing general, gynaecological, orthopaedic, and vascular surgery during 1995–2009 were retrospectively analysed. Postoperative hypoxia, unplanned ICU-admission, surgical site infection (SSI), postoperative nausea and vomiting (PONV), and hospital mortality were continuously recorded. During 1996 the anaesthetic ventilation for all patients was changed from 30% oxygen plus 70% nitrous oxide to 100% oxygen in low-flow mode. Therefore, in order to minimize the potential of confounding due to a variety of treatments being used, we directly compared years 1995 (30% oxygen) and 1997 (100%), whereas the period 1998 to 2009 is simply described. Results. Comparing 1995 to 1997 pure oxygen ventilation led to a decreased incidence of postoperative hypoxic events (4.3 to 3.0%; p < 0.0001) and hospital mortality (2.1 to 1.6%; p = 0.088) as well as SSI (8.0 to 5.0%; p < 0.0001) and PONV (21.6 to 17.5%; p < 0.0001). There was no effect on unplanned ICU-admission (1.1 to 0.9; p = 0.18). Conclusions. The observed effects may be partly due to pure oxygen ventilation, abandonment of nitrous oxide, and application of low-flow anesthesia. Pure oxygen ventilation during general anaesthesia is harmless, as long as certain standards are adhered to. It makes anaesthesia simpler and safer and may reduce clinical morbidity, such as postoperative hypoxia and surgical site infection.
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Affiliation(s)
- Benno von Bormann
- Department of Anesthesiology, Siriraj Hospital, Mahidol-University , Bangkoknoi, Bangkok , Thailand
| | - Sirilak Suksompong
- Department of Anesthesiology, Siriraj Hospital, Mahidol-University , Bangkoknoi, Bangkok , Thailand
| | | | - Rolf Zander
- Department of Physiology, Johannes Gutenberg-University , Saarstraße, Mainz , Germany
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Abstract
Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.
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46
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EDMARK L, AUNER U, LINDBÄCK J, ENLUND M, HEDENSTIERNA G. Post-operative atelectasis - a randomised trial investigating a ventilatory strategy and low oxygen fraction during recovery. Acta Anaesthesiol Scand 2014; 58:681-8. [PMID: 24720763 DOI: 10.1111/aas.12322] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atelectasis is common during and after general anaesthesia. We hypothesized that a ventilation strategy with a combination of 1) continuous positive airway pressure (CPAP) or positive end-expiratory pressure (PEEP) and 2) a reduced end-expiratory oxygen concentration during recovery would reduce post-operative atelectasis. METHODS Sixty patients were randomized into two groups. During anaesthesia induction, inspiratory oxygen fraction (FIO2) was 1.0, and depending on weight, CPAP 6, 7 or 8 cmH2O was applied in both groups via facemask. During maintenance of anaesthesia, a laryngeal mask airway (LMA) was used, and PEEP was 6-8 cmH2O in both groups. Before removal of the LMA, FIO2 was set to 0.3 in the intervention group and 1.0 in the control group. Atelectasis was studied by computed tomography (CT) approximately 14 min post-operatively. RESULTS In one patient in the group given an FIO2 of 0.3 before removal of the LMA a CT scan could not be performed so the patient was excluded. The area of atelectasis was 5.5, 0-16.9 cm(2) (median and range), and 6.8, 0-27.5 cm(2) in the groups given FIO2 0.3 or FIO2 1.0 before removal of the LMA, a difference that was not statistically significant (P = 0.48). Post-hoc analysis showed dependence of atelectasis on smoking (despite all were clinically lung healthy) and American Society of Anesthesiologists class (P = 0.038 and 0.015, respectively). CONCLUSION Inducing anaesthesia with CPAP/PEEP and FIO2 1.0 and deliberately reducing FIO2 during recovery before removal of the LMA did not reduce post-operative atelectasis compared with FIO2 1.0 before removal of the LMA.
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Affiliation(s)
- L. EDMARK
- Department of Anaesthesiology and Intensive Care; Västmanlands sjukhus Köping; Köping Sweden
- Department of Medical Sciences; Clinical Physiology; Uppsala University; Uppsala Sweden
| | - U. AUNER
- Department of Radiology; Västmanlands sjukhus Västerås; Västerås Sweden
| | - J. LINDBÄCK
- Uppsala Clinical Research Center; Uppsala University; Uppsala Sweden
| | - M. ENLUND
- Centre for Clinical Research; Västmanlands sjukhus Västerås; Västerås Sweden
| | - G. HEDENSTIERNA
- Department of Medical Sciences; Clinical Physiology; Uppsala University; Uppsala Sweden
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47
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Pulmonary Function after Emergence on 100% Oxygen in Patients with Chronic Obstructive Pulmonary Disease. Anesthesiology 2014; 120:1146-51. [DOI: 10.1097/aln.0000000000000161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Background:
During emergence from anesthesia, breathing 100% oxygen is frequently used to provide a safety margin toward hypoxemia in case an airway problem occurs. Oxygen breathing has been shown to cause pulmonary gas exchange disorders in healthy individuals. This study investigates how oxygen breathing during emergence affects lung function specifically whether oxygen breathing causes added hypoxemia in patients with chronic obstructive pulmonary disease.
Methods:
This trial has been conducted in a parallel-arm, case-controlled, open-label manner. Fifty-three patients with chronic obstructive pulmonary disease were randomly allocated (computer-generated lists) to breathe either 100 or 30% oxygen balanced with nitrogen during emergence from anesthesia. Arterial blood gas measurements were taken before induction and at 5, 15, and 60 min after extubation.
Results:
All participants tolerated the study well. Patients treated with 100% oxygen had a higher alveolar–arterial oxygen pressure gradient (primary outcome) compared with patients treated with 30% oxygen (25 vs. 20 mmHg) and compared with their baseline at the 60-min measurement (25 vs. 17 mmHg). At the 60-min measurement, arterial partial pressure of oxygen was lower in the 100% group (62 vs. 67 mmHg). Arterial partial pressure of carbon dioxide and pH were not different between groups or measurements.
Conclusions:
In this experiment, the authors examined oxygen breathing during emergence—a widely practiced maneuver known to generate pulmonary blood flow heterogeneity. In the observed cohort of patients already presenting with pulmonary blood flow disturbances, emergence on oxygen resulted in deterioration of oxygen-related blood gas parameters. In the perioperative care of patients with chronic obstructive pulmonary disease, oxygen breathing during emergence from anesthesia may need reconsideration.
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48
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Hällsjö Sander C, Hallbäck M, Wallin M, Emtell P, Oldner A, Björne H. Novel continuous capnodynamic method for cardiac output assessment during mechanical ventilation. Br J Anaesth 2014; 112:824-31. [DOI: 10.1093/bja/aet486] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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49
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Rokamp KZ, Secher NH, Eiberg J, Lønn L, Nielsen HB. O2 supplementation to secure the near-infrared spectroscopy determined brain and muscle oxygenation in vascular surgical patients: a presentation of 100 cases. Front Physiol 2014; 5:66. [PMID: 24611051 PMCID: PMC3933814 DOI: 10.3389/fphys.2014.00066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 02/03/2014] [Indexed: 12/27/2022] Open
Abstract
This study addresses three questions for securing tissue oxygenation in brain (rScO2) and muscle (SmO2) for 100 patients (age 71 ± 6 years; mean ± SD) undergoing vascular surgery: (i) Does preoxygenation (inhaling 100% oxygen before anesthesia) increase tissue oxygenation, (ii) Does inhalation of 70% oxygen during surgery prevent a critical reduction in rScO2 (<50%), and (iii) is a decrease in rScO2 and/or SmO2 related to reduced blood pressure and/or cardiac output?Intravenous anesthesia was provided to all patients and the intraoperative inspired oxygen fraction was set to 0.70 while tissue oxygenation was determined by INVOS 5100C. Preoxygenation increased rScO2 (from 65 ± 8 to 72 ± 9%; P < 0.05) and SmO2 (from 75 ± 9 to 78 ± 9%; P < 0.05) and during surgery rScO2 and SmO2 were maintained at the baseline level in most patients. Following anesthesia and tracheal intubation an eventual change in rScO2 correlated to cardiac output and cardiac stroke volume (coefficient of contingence = 0.36; P = 0.0003) rather to a change in mean arterial pressure and for five patients rScO2 was reduced to below 50%. We conclude that (i) increased oxygen delivery enhances tissue oxygenation, (ii) oxygen supports tissue oxygenation but does not prevent a critical reduction in cerebral oxygenation sufficiently, and (iii) an eventual decrease in tissue oxygenation seems related to a reduction in cardiac output rather than to hypotension.
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Affiliation(s)
- Kim Z Rokamp
- Departments of Anesthesia, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
| | - Niels H Secher
- Departments of Anesthesia, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
| | - Jonas Eiberg
- Vascular Surgery, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
| | - Lars Lønn
- Interventional Radiology, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
| | - Henning B Nielsen
- Departments of Anesthesia, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
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50
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STAEHR-RYE AK, RASMUSSEN LS, ROSENBERG J, STEEN-HANSEN C, NIELSEN TF, ROSENSTOCK CV, CLAUSEN HV, SØRENSEN MK, VON H. REGEUR J, GÄTKE MR. Minimal impairment in pulmonary function following laparoscopic surgery. Acta Anaesthesiol Scand 2014; 58:198-205. [PMID: 24383568 DOI: 10.1111/aas.12254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pulmonary function may be impaired in connection with laparoscopic surgery, especially in the head-down body position, but the clinical importance has not been assessed in detail. The aim of this study was to assess pulmonary function after laparoscopic hysterectomy and laparoscopic cholecystectomy. We hypothesised that arterial oxygenation would be more impaired after hysterectomy performed in the head-down position than after cholecystectomy in the head-up position. METHODS We included 60 women in this prospective, observational study. The patients underwent elective laparoscopic cholecystectomy in the 20° head-up position or hysterectomy in the 30° head-down position. The primary outcome was the difference between arterial oxygenation (PaO2 ) 2 h postoperatively and the preoperative value. Two hours and 24 h after surgery, pulmonary shunt and ventilation-perfusion mismatch were assessed by use of an automatic lung parameter estimation system. RESULTS Two hours after surgery, the mean change from baseline in PaO2 was -0.65 kPa [95% confidence interval (CI) -3.5 to 3.4, P = 0.14] in the hysterectomy group and -0.22 kPa [95% CI -3.4 to 2.0, P = 0.12] in the cholecystectomy group (P = 0.88). Shunt was significantly greater in the cholecystectomy group 24 h after surgery compared to the hysterectomy group [4%, 95% CI 0 to 9 vs. 0%, 95% CI 0 to 7, P = 0.02]. CONCLUSIONS Minimal impairment in pulmonary gas exchange was found after laparoscopic surgery. Pulmonary shunt was larger after laparoscopic cholecystectomy, but no clinically significant differences in postoperative pulmonary gas exchange or spirometry were found between laparoscopic hysterectomy and laparoscopic cholecystectomy.
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Affiliation(s)
- A. K. STAEHR-RYE
- Department of Anaesthesiology; University of Copenhagen, Herlev Hospital; Herlev Denmark
| | - L. S. RASMUSSEN
- Department of Anaesthesia, Centre of Head and Orthopaedics; University of Copenhagen, Rigshospitalet; Copenhagen Denmark
| | - J. ROSENBERG
- Department of Surgery; University of Copenhagen, Herlev Hospital; Herlev Denmark
| | - C. STEEN-HANSEN
- Department of Anaesthesiology; Nordsjaellands Hospital, University of Copenhagen; Capital Region of Denmark Denmark
| | - T. F. NIELSEN
- Department of Gynaecological and Obstetrics; University of Copenhagen, Herlev Hospital; Herlev Denmark
| | - C. V. ROSENSTOCK
- Department of Anaesthesiology; Nordsjaellands Hospital, University of Copenhagen; Capital Region of Denmark Denmark
| | - H. V. CLAUSEN
- Department of Gynaecological and Obstetrics; University of Copenhagen, Herlev Hospital; Herlev Denmark
| | - M. K. SØRENSEN
- Department of Anaesthesia, Centre of Head and Orthopaedics; University of Copenhagen, Rigshospitalet; Copenhagen Denmark
| | - J. VON H. REGEUR
- Department of Surgery; Nordsjaellands Hospital, University of Copenhagen; Capital Region of Denmark Denmark
| | - M. R. GÄTKE
- Department of Anaesthesiology; University of Copenhagen, Herlev Hospital; Herlev Denmark
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