Document Detail

Optimal positive end-expiratory pressure (PEEP) settings in differential lung ventilation during simultaneous unilateral pneumothorax and laparoscopy: an experimental study in pigs.
MedLine Citation:
PMID:  11965469     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: A combined thoraco-laparoscopic technique for esophageal resection is technically possible, but it requires special attention to ventilation. The positive insufflation pressure normally used in laparoscopy will, when communication between thorax and abdomen is established, create a pneumothorax. METHODS: We performed an experimental study of differential lung ventilation with different levels of positive end-expiratory pressure (PEEP) settings during thoraco-laparoscopy in anesthetized pigs. RESULTS: Positive pressure insufflation of carbon dioxide (CO2) resulted in elevated pulmonary capillary wedge pressure, hypercarbia, and respiratory acidosis. Hypoxemia, however, developed only at lower settings of PEEP. Heart rate, mean arterial pressure, and cardiac output remained relatively stable. CONCLUSION: Pneumopleuroperitoneum under positive CO2 insufflation pressure had adverse effects on blood gases. Hypercarbia, respiratory acidosis, and hypoxemia were early manifestations that occurred even in the presence of hemodynamic stability. The application of PEEP equal to or above CO2 insufflation pressure improved blood gases; in particular, the hypoxia could be avoided. No beneficial effects of differential lung ventilation were documented.
R Sandbu; B Birgisdottir; D Arvidsson; U Sjöstrand; S Rubertsson
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Surgical endoscopy     Volume:  15     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2001 Dec 
Date Detail:
Created Date:  2002-04-19     Completed Date:  2002-05-10     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1478-83     Citation Subset:  IM    
Department of Surgery, Uppsala University Hospital, SE-751 85 Uppsala, Sweden.
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MeSH Terms
Carbon Dioxide / administration & dosage,  adverse effects
Hemodynamics / drug effects
Hypercapnia / etiology
Insufflation / methods
Laparoscopy / methods*
Pneumothorax, Artificial / methods*
Positive-Pressure Respiration / methods*
Pulmonary Gas Exchange / physiology
Pulmonary Wedge Pressure / drug effects
Reg. No./Substance:
124-38-9/Carbon Dioxide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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