Multimodal non-invasive monitoring to apply an open lung approach strategy in morbidly obese patients during bariatric surgery

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Multimodal non-invasive monitoring to apply an open lung approach strategy in morbidly obese patients during bariatric surgery

Tusman, Gerardo (author): Hosp Privado Comunidad Mar Del Plata, Dept Anesthesiol, RA-7600 Mar Del Plata, Buenos Aires, Argentina.

Acosta, Cecilia M. (author): Hosp Privado Comunidad Mar Del Plata, Dept Anesthesiol, RA-7600 Mar Del Plata, Buenos Aires, Argentina.

Ochoa, Marcos (author): Hosp Privado Comunidad Mar Del Plata, Dept Anesthesiol, RA-7600 Mar Del Plata, Buenos Aires, Argentina.

Boehm, Stephan H. (author): Univ Rostock, Med Ctr, Dept Anesthesiol & Intens Care Med, Rostock, Germany.

Gogniat, Emiliano (author): Argentinians Intens Care Soc, Buenos Aires, DF, Argentina.

Martinez Arca, Jorge (author): Mar Del Plata Univ, Sch Engn, Elect Dept, Bioengn Lab, Mar Del Plata, Buenos Aires, Argentina.

Scandurra, Adriana (author): Mar Del Plata Univ, Sch Engn, Elect Dept, Bioengn Lab, Mar Del Plata, Buenos Aires, Argentina.

Madorno, Matias (author): ITBA, Buenos Aires, DF, Argentina.

Ferrando, Carlos (author): Hosp Clin Barcelona, Deparment Anesthesiol & Crit Care, Barcelona, Spain.

Suarez-Sipmann, Fernando (author): Uppsala universitet,Anestesiologi och intensivvård,Hedenstiernalaboratoriet,CIBERES, Madrid, Spain.;Univ Autonoma Madrid, Hosp Univ Princesa, Dept Crit Care, Madrid, Spain.

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Hosp Privado Comunidad Mar Del Plata, Dept Anesthesiol, RA-7600 Mar Del Plata, Buenos Aires, Argentina Univ Rostock, Med Ctr, Dept Anesthesiol & Intens Care Med, Rostock, Germany. (creator_code:org_t)

2019-10-25
2020
English.
In: Journal of clinical monitoring and computing. - : SPRINGER HEIDELBERG. - 1387-1307 .- 1573-2614. ; 34:5, s. 1015-1024

Related links:: https://urn.kb.se/re...; show more...; https://doi.org/10.1...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

To evaluate the use of non-invasive variables for monitoring an open-lung approach (OLA) strategy in bariatric surgery. Twelve morbidly obese patients undergoing bariatric surgery received a baseline protective ventilation with 8 cmH(2)O of positive-end expiratory pressure (PEEP). Then, the OLA strategy was applied consisting in lung recruitment followed by a decremental PEEP trial, from 20 to 8 cmH(2)O, in steps of 2 cmH(2)O to find the lung's closing pressure. Baseline ventilation was then resumed setting open lung PEEP (OL-PEEP) at 2 cmH(2)O above this pressure. The multimodal non-invasive variables used for monitoring OLA consisted in pulse oximetry (SpO(2)), respiratory compliance (Crs), end-expiratory lung volume measured by a capnodynamic method (EELVCO2), and esophageal manometry. OL-PEEP was detected at 15.9 +/- 1.7 cmH(2)O corresponding to a positive end-expiratory transpulmonary pressure (P-L,P-ee) of 0.9 +/- 1.1 cmH(2)O. ROC analysis showed that SpO(2) was more accurate (AUC 0.92, IC95% 0.87-0.97) than Crs (AUC 0.76, IC95% 0.87-0.97) and EELVCO2 (AUC 0.73, IC95% 0.64-0.82) to detect the lung's closing pressure according to the change of P-L,P-ee from positive to negative values. Compared to baseline ventilation with 8 cmH(2)O of PEEP, OLA increased EELVCO2 (1309 +/- 517 vs. 2177 +/- 679 mL) and decreased driving pressure (18.3 +/- 2.2 vs. 10.1 +/- 1.7 cmH(2)O), estimated shunt (17.7 +/- 3.4 vs. 4.2 +/- 1.4%), lung strain (0.39 +/- 0.07 vs. 0.22 +/- 0.06) and lung elastance (28.4 +/- 5.8 vs. 15.3 +/- 4.3 cmH(2)O/L), respectively; all p < 0.0001. The OLA strategy can be monitored using noninvasive variables during bariatric surgery. This strategy decreased lung strain, elastance and driving pressure compared with standard protective ventilatory settings. Clinical trial number NTC03694665.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)

Keyword

PEEP
Lung recruitment
Atelectasis
Capnography
Morbid obesity
Pulse oximetry
Bariatric surgery

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