| Positive end-expiratory pressure improves end-expiratory lung volume but not oxygenation after induction of anaesthesia. | |
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MedLine Citation:
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PMID: 20404729 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND OBJECTIVE: Induction of anaesthesia promotes collapse of dependent lung regions in both obese and nonobese patients. We hypothesized that end-expiratory lung volume (EELV) may be more sensitive than oxygenation to evaluate the effects of positive end-expiratory pressure (PEEP) after anaesthesia induction. METHODS: Forty patients (20 nonobese patients and 20 obese patients) were prospectively studied. After anaesthesia induction, PEEP was adjusted in a stepwise fashion [zero end-expiratory pressure (ZEEP), PEEP 5 cmH2O and PEEP 10 cmH2O]. At each step, we measured EELV, static elastance, gas exchange and dead space. Other than changing PEEP, respiratory settings were kept constant throughout. RESULTS: Anaesthesia induction and ZEEP both lowered EELV by 39% in nonobese patients and 59% in obese patients (both P < 0.05), as well as oxygenation (P < 0.05). Compared with ZEEP, in nonobese patients, PEEP 5 cmH2O and PEEP 10 cmH2O improved EELV (+15 and +40%, respectively, P < 0.01) and elastance but not oxygenation. In obese patients, PEEP 10 cmH2O also improved EELV (49% vs. ZEEP and 30% vs. PEEP 5 cmH2O, P < 0.01), elastance and dead-space fraction, with no effect on oxygenation. PEEP-induced changes of EELV correlated with changes of elastance (r = 0.46, P = 0.003), but not with oxygenation. CONCLUSION: After induction of anaesthesia, mechanical ventilation with ZEEP is associated with a profound reduction in EELV. PEEP improves efficiently EELV and respiratory mechanics, with no major effect on oxygenation. EELV may be a useful indicator to guide PEEP setting in the operating room. |
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Authors:
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Emmanuel Futier; Jean-Michel Constantin; Antoine Petit; Boris Jung; Fabrice Kwiatkowski; Martine Duclos; Samir Jaber; Jean-Etienne Bazin |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: European journal of anaesthesiology Volume: 27 ISSN: 1365-2346 ISO Abbreviation: Eur J Anaesthesiol Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-05-05 Completed Date: 2010-11-12 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8411711 Medline TA: Eur J Anaesthesiol Country: England |
Other Details:
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Languages: eng Pagination: 508-13 Citation Subset: IM |
Affiliation:
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Department of Anaesthesiology and Critical Care, Hotel-Dieu Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France. efutier@chu-clermontferrand.fr |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Anesthesia, General
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methods* Blood Pressure / physiology Female Heart Rate / physiology Humans Male Middle Aged Obesity / complications, surgery* Oxygen* / administration & dosage, analysis Positive-Pressure Respiration / methods* Prospective Studies Respiratory Function Tests Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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7782-44-7/Oxygen |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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