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Yueyi J, Jing T, Lianbing G. A structured narrative review of clinical and experimental studies of the use of different positive end-expiratory pressure levels during thoracic surgery. THE CLINICAL RESPIRATORY JOURNAL 2022; 16:717-731. [PMID: 36181340 PMCID: PMC9629996 DOI: 10.1111/crj.13545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/03/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES This study aimed to present a review on the general effects of different positive end-expiratory pressure (PEEP) levels during thoracic surgery by qualitatively categorizing the effects into detrimental, beneficial, and inconclusive. DATA SOURCE Literature search of Pubmed, CNKI, and Wanfang was made to find relative articles about PEEP levels during thoracic surgery. We used the following keywords as one-lung ventilation, PEEP, and thoracic surgery. RESULTS We divide the non-individualized PEEP value into five grades, that is, less than 5, 5, 5-10, 10, and more than 10 cmH2 O, among which 5 cmH2 O is the most commonly used in clinic at present to maintain alveolar dilatation and reduce the shunt fraction and the occurrence of atelectasis, whereas individualized PEEP, adjusted by test titration or imaging method to adapt to patients' personal characteristics, can effectively ameliorate intraoperative oxygenation and obtain optimal pulmonary compliance and better indexes relating to respiratory mechanics. CONCLUSIONS Available data suggest that PEEP might play an important role in one-lung ventilation, the understanding of which will help in exploring a simple and economical method to set the appropriate PEEP level.
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Affiliation(s)
- Jiang Yueyi
- The Affiliated Cancer Hospital of Nanjing Medical UniversityNanjingChina
| | - Tan Jing
- Department of AnesthesiologyJiangsu Cancer HospitalNanjingChina
| | - Gu Lianbing
- The Affiliated Cancer Hospital of Nanjing Medical UniversityNanjingChina,Department of AnesthesiologyJiangsu Cancer HospitalNanjingChina
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Rupp T, Maufrais C, Walther G, Esteve F, Macdonald JH, Bouzat P, Verges S. MEDEX 2015: Prophylactic Effects of Positive Expiratory Pressure in Trekkers at Very High Altitude. Front Physiol 2021; 12:710622. [PMID: 34621182 PMCID: PMC8490760 DOI: 10.3389/fphys.2021.710622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Positive expiratory pressure (PEP) breathing has been shown to increase arterial oxygenation during acute hypoxic exposure but the underlying mechanisms and consequences on symptoms during prolonged high-altitude exposure remain to be elucidated. Methods: Twenty-four males (41 ± 16 years) were investigated, at sea level and at 5,085 m after 18 days of trekking from 570 m. Participants breathed through a face-mask with PEP = 0 cmH2O (PEP0, 0-45th min) and with PEP = 10 cmH2O (PEP10, 46-90th min). Arterial (SpO2), quadriceps and prefrontal (near infrared spectroscopy) oxygenation was measured continuously. Middle cerebral artery blood velocity (MCAv, transcranial Doppler), cardiac function (2D-echocardiography), extravascular lung water accumulation (UsLC, thoracic ultrasound lung comets) and acute mountain sickness (Lake Louise score, LLS) were assessed during PEP0 and PEP10. Results: At 5,085 m with PEP0, SpO2 was 78 ± 4%, UsLC was 8 ± 5 (a.u.) and the LLS was 2.3 ± 1.7 (all P < 0.05 versus sea level). At 5,085 m, PEP10 increased significantly SpO2 (+9 ± 5%), quadriceps (+2 ± 2%) and prefrontal cortex (+2 ± 2%) oxygenation (P < 0.05), and decreased significantly MCAv (-16 ± 14 cm.s-1) and cardiac output (-0.7 ± 1.2 L.min-1) together with a reduced stroke volume (-9 ± 15 mL, all P < 0.05) and no systemic hypotension. PEP10 decreased slightly the number of UsLC (-1.4 ± 2.7, P = 0.04) while the incidence of acute mountain sickness (LLS ≥ 3) fell from 42% with PEP0 to 25% after PEP10 (P = 0.043). Conclusion: PEP10 breathing improved arterial and tissue oxygenation and symptoms of acute mountain sickness after trekking to very high altitude, despite reduced cerebral perfusion and cardiac output. Further studies are required to establish whether PEP-breathing prophylactic mechanisms also occur in participants with more severe acute mountain sickness.
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Affiliation(s)
- Thomas Rupp
- Inter-University Laboratory of Human Movement Science (LIBM), University Savoie Mont Blanc, Chambéry, France
| | - Claire Maufrais
- Laboratoire de Pharm-Ecologie Cardiorespiratoire (LAPEC EA4278), Avignon University, Avignon, France.,HP2 Laboratory, INSERM, Grenoble Alpes University, Grenoble, France
| | - Guillaume Walther
- Laboratoire de Pharm-Ecologie Cardiorespiratoire (LAPEC EA4278), Avignon University, Avignon, France
| | - François Esteve
- RSRM EA7442, ID17-ESRF, Grenoble Alpes University, Grenoble, France
| | - Jamie Hugo Macdonald
- Extremes Research Group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor, United Kingdom
| | - Pierre Bouzat
- Pôle Anesthésie Réanimation, Grenoble Alpes University Hospital, Grenoble, France
| | - Samuel Verges
- HP2 Laboratory, INSERM, Grenoble Alpes University, Grenoble, France
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Carr J, Stone R, Tymko C, Tymko K, Coombs GB, Hoiland RL, Howe CA, Tymko MM, Ainslie PN, Patrician A. Global REACH 2018: The Effect of an Expiratory Resistance Mask with Dead Space on Sleep and Acute Mountain Sickness During Acute Exposure to Hypobaric Hypoxia. High Alt Med Biol 2020; 21:297-302. [DOI: 10.1089/ham.2019.0124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Jay Carr
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia–Okanagan Campus, Kelowna, Canada
| | - Rachel Stone
- Department of Kinesiology, University of Windsor, Windsor, Canada
| | - Courtney Tymko
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia–Okanagan Campus, Kelowna, Canada
| | - Kaitlyn Tymko
- Department of Kinesiology, University of Manitoba, Winnipeg, Canada
| | - Geoff B. Coombs
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia–Okanagan Campus, Kelowna, Canada
| | - Ryan L. Hoiland
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia–Okanagan Campus, Kelowna, Canada
- Department of Anaesthesiology, Pharmacology, and Therapeutics, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Connor A. Howe
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia–Okanagan Campus, Kelowna, Canada
| | - Michael M. Tymko
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia–Okanagan Campus, Kelowna, Canada
| | - Philip N. Ainslie
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia–Okanagan Campus, Kelowna, Canada
| | - Alexander Patrician
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia–Okanagan Campus, Kelowna, Canada
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Crouse SF, Lytle JR, Boutros S, Benton W, Moreno M, McCulloch PC, Lambert BS. Wearable positive end-expiratory pressure valve improves exercise performance. SPORTS MEDICINE AND HEALTH SCIENCE 2020; 2:159-165. [PMID: 35782287 PMCID: PMC9219351 DOI: 10.1016/j.smhs.2020.06.002] [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: 05/13/2020] [Revised: 06/13/2020] [Accepted: 06/19/2020] [Indexed: 11/30/2022] Open
Abstract
We tested a PEEP (4.2 cmH2O) mouthpiece (PMP) on maximal cycling performance in healthy adults. Experiment-1, PMP vs. non-PMP mouthpiece (CON) [n = 9 (5♂), Age = 30 ± 2 yr]; Experiment-2, PMP vs. no mouthpiece (NMP) [n = 10 (7♂), Age = 27 ± 1 yr]. At timepoint 1 in both experiments (mouthpiece condition randomized) subjects performed graded cycling testing (GXT) (Corival® cycle ergometer) to determine V˙O2peak (ml∗kg∗min−1), O2pulse (mlO2∗bt−1), GXT endurance time (GXT-T(s)), and V˙O2(ml∗kg∗min−1)-at-ventilatory-threshold (V˙O2 @VT). At timepoint 2 72 h later, subjects completed a ventilatory-threshold-endurance-ride [VTER(s)] timed to exhaustion at V˙O2 @VT power (W). One week later at timepoints 3 and 4 (time-of-day controlled), subjects repeated testing protocols under the alternate mouthpiece condition. Selected results (paired T-test, p<0.05): Experiment 1 PMP vs. CON, respectively: V˙O2peak = 45.2 ± 2.4 vs. 42.4 ± 2.3 p<0.05; V˙O2@VT = 33.7 ± 2.0 vs. 32.3 ± 1.6; GXT-TTE = 521.7 ± 73.4 vs. 495.3 ± 72.8 (p<0.05); VTER = 846.2 ± 166.0 vs. 743.1 ± 124.7; O2pulse = 24.5 ± 1.4 vs. 23.1 ± 1.3 (p<0.05). Experiment 2 PMP vs. NMP, respectively: V˙O2peak = 43.3 ± 1.6 vs. 41.7 ± 1.6 (p<0.05); V˙O2@VT = 31.1 ± 1.2 vs. 29.1 ± 1.3 (p<0.05); GXT-TTE = 511.7 ± 49.6 vs. 486.4 ± 49.6 (p<0.05); VTER 872.4 ± 134.0 vs. 792.9 ± 122.4; O2pulse = 24.1 ± 0.9 vs. 23.4 ± 0.9 (p<0.05). Results demonstrate that the PMP conferred a significant performance benefit to cyclists completing high intensity cycling exercise.
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Affiliation(s)
- Stephen F. Crouse
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
- Corresponding author. Department of Health and Kinesiology Texas A&M University, 4245 TAMU, College Station, TX, 77843, USA.
| | - Jason R. Lytle
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | - Sean Boutros
- My Houston Surgeons, 9230 Katy Freeway, Suite 600, Houston, TX, USA
| | - William Benton
- PEEP Performance, LLC., 96 Siwanoy Blvd, Eastchester, NY, USA
| | - Michael Moreno
- Department of Mechanical Engineering, Texas A&M University, College Station, TX, USA
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Zhou L, Cai G, Xu Z, Weng Q, Ye Q, Chen C. High positive end expiratory pressure levels affect hemodynamics in elderly patients with hypertension admitted to the intensive care unit: a prospective cohort study. BMC Pulm Med 2019; 19:224. [PMID: 31775701 PMCID: PMC6882021 DOI: 10.1186/s12890-019-0965-9] [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: 11/28/2017] [Accepted: 10/18/2019] [Indexed: 01/18/2023] Open
Abstract
Background To study the effects of different positive end expiratory pressure (PEEP) on blood pressure and heart function in elderly patients with hypertension. Methods Forty elderly patients above 65 years of age treated with mechanical ventilation were divided into two groups: a control group of non-hypertensive subjects (n = 18) and a hypertension group (n = 22) patients with essential hypertension. Changes in blood pressure, central venous pressure (CVP), central venous oxygen saturation (ScvO2), heart rate, and airway pressure were determined in response to different selected PEEP levels of 0, 2, 4, 6, 8, 10 and 12 cm H2O under SIMV(PC) + PSV mode throughout the study. Results In both groups, the increase in PEEP led to an increase in CVP and airway pressure. When PEEP was above 4 cm H2O in the hypertension group, a decrease in blood pressure and ScvO2, and an increase of heart rate were observed. These results indicated that cardiac output significantly decreased. Conclusion High levels of PEEP can significantly influence changes in blood pressure and heart function in elderly patients with hypertension. Trial registration This trial was retrospectively registered, The Chinese trial registration number is ChiCTR-ROC-17012873. The date of registration is 10-2-2017.
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Affiliation(s)
- Lili Zhou
- Department of Geriatrics, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China.,Department of Critical Care Medicine, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China
| | - Guoen Cai
- Department of Geriatrics, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China.,Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China
| | - Zhihui Xu
- Department of Geriatrics, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China.,Department of Critical Care Medicine, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China
| | - Qinyong Weng
- Department of Geriatrics, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China.,Department of Critical Care Medicine, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China
| | - Qinyong Ye
- Department of Geriatrics, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China.,Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China
| | - Cunrong Chen
- Department of Geriatrics, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China. .,Department of Critical Care Medicine, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China.
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Rupp T, Saugy JJ, Bourdillon N, Verges S, Millet GP. Positive expiratory pressure improves arterial and cerebral oxygenation in acute normobaric and hypobaric hypoxia. Am J Physiol Regul Integr Comp Physiol 2019; 317:R754-R762. [PMID: 31530174 DOI: 10.1152/ajpregu.00025.2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Positive expiratory pressure (PEP) has been shown to limit hypoxia-induced reduction in arterial oxygen saturation, but its effectiveness on systemic and cerebral adaptations, depending on the type of hypoxic exposure [normobaric (NH) versus hypobaric (HH)], remains unknown. Thirteen healthy volunteers completed three randomized sessions consisting of 24-h exposure to either normobaric normoxia (NN), NH (inspiratory oxygen fraction, FiO2 = 13.6%; barometric pressure, BP = 716 mmHg; inspired oxygen partial pressure, PiO2 = 90.9 ± 1.0 mmHg), or HH (3,450 m, FiO2 = 20.9%, BP = 482 mmHg, PiO2 = 91.0 ± 0.6 mmHg). After the 6th and the 22nd hours, participants breathed quietly through a facemask with a 10-cmH2O PEP for 2 × 5 min interspaced with 5 min of free breathing. Arterial (SpO2, pulse oximetry), quadriceps, and cerebral (near-infrared spectroscopy) oxygenation, middle cerebral artery blood velocity (MCAv; transcranial Doppler), ventilation, and cardiovascular responses were recorded continuously. SpO2without PEP was significantly lower in HH (87 ± 4% on average for both time points, P < 0.001) compared with NH (91 ± 3%) and NN (97 ± 1%). PEP breathing did not change SpO2 in NN but increased it similarly in NH and HH (+4.3 ± 2.5 and +4.7 ± 4.1% after 6h; +3.5 ± 2.2 and +4.1 ± 2.9% after 22h, both P < 0.001). Although MCAv was reduced by PEP (in all sessions and at all time points, -6.0 ± 4.2 cm/s on average, P < 0.001), the cerebral oxygenation was significantly improved (P < 0.05) with PEP in both NH and HH, with no difference between conditions. These data indicate that PEP could be an attractive nonpharmacological means to improve arterial and cerebral oxygenation under both normobaric and hypobaric mild hypoxic conditions in healthy participants.
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Affiliation(s)
- Thomas Rupp
- Laboratoire Interuniversitaire de Biologie de la Motricité, Inter-University Laboratory of Human Movement Science, University Savoie Mont Blanc, Chambery, France
| | - Jonas J Saugy
- Institute of Sport Sciences of the University of Lausanne, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Nicolas Bourdillon
- Institute of Sport Sciences of the University of Lausanne, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Samuel Verges
- Hypoxia-pathophysiology 2 Laboratory, Grenoble Alpes University, France.,Unité 1042, INSERM, Grenoble, Grenoble, France
| | - Grégoire P Millet
- Institute of Sport Sciences of the University of Lausanne, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Patrician A, Tymko MM, Caldwell HG, Howe CA, Coombs GB, Stone R, Hamilton A, Hoiland RL, Ainslie PN. The Effect of an Expiratory Resistance Mask with Dead Space on Sleep, Acute Mountain Sickness, Cognition, and Ventilatory Acclimatization in Normobaric Hypoxia. High Alt Med Biol 2019; 20:61-70. [PMID: 30720346 DOI: 10.1089/ham.2018.0074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We examined the hypothesis that an expiratory resistance mask containing a small amount of dead space (ER/DS) would reduce the apnea-hypopnea index (AHI) during sleep, attenuate the severity of acute mountain sickness (AMS), and offset decrements in cognitive function compared with a sham mask. In a double-blinded, randomized, sham-controlled, crossover design, 19 volunteers were exposed to two nights of normobaric hypoxia (FIO2 = 0.125), using a ER/DS mask (3.5 mm restrictive expiratory orifice; 125 mL DS volume) and sham mask (zero-flow resistance; 50 mL DS volume). Cognitive function, AMS, and ventilatory acclimatization were assessed before and after the 12-hour normobaric hypoxia exposure. Polysomnography was conducted during sleep. AHI was reduced using the ER/DS sleep mask compared with the sham (30.1 ± 23.9 events·hr-1 vs. 58.9 ± 34.4 events·hr-1, respectively; p = 0.01). Likewise, oxygen desaturation index and headache severity were reduced (both p < 0.05). There were also benefits on limiting the hypoxia-induced reductions in select measures of reaction speed and attention (p < 0.05). Our study indicates that a simple noninvasive and portable ER/DS mask resulted in reductions (49%) in AHI, and reduced headache severity and aspects of cognitive decline. The field applications of this ER/DS mask should be investigated before recommendations can be made to support its benefit for travel to high altitude.
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Affiliation(s)
- Alexander Patrician
- Center for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Kelowna, Canada
| | - Michael M Tymko
- Center for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Kelowna, Canada
| | - Hannah G Caldwell
- Center for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Kelowna, Canada
| | - Connor A Howe
- Center for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Kelowna, Canada
| | - Geoff B Coombs
- Center for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Kelowna, Canada
| | - Rachel Stone
- Center for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Kelowna, Canada
| | - Allison Hamilton
- Center for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Kelowna, Canada
| | - Ryan L Hoiland
- Center for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Kelowna, Canada
| | - Philip N Ainslie
- Center for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Kelowna, Canada
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Sightings edited by Erik R. Swenson and Peter Bärtsch. High Alt Med Biol 2014. [DOI: 10.1089/ham.2014.1533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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