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  • Ferrando, Carlos (författare)

Open lung approach versus standard protective strategies Effects on driving pressure and ventilatory efficiency during anesthesia - A pilot, randomized controlled trial

  • E-artikel/E-kapitelEngelska2017

Förlag, utgivningsår, omfång ...

  • PUBLIC LIBRARY SCIENCE2017

Nummerbeteckningar

  • LIBRIS-ID:21081235
  • http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-326245uri
  • urn:nbn:se:uu:diva-326245urn
  • 10.1371/journal.pone.0177399doi

Kompletterande språkuppgifter

  • Språk:engelska

Ingår i deldatabas

Anmärkningar

  • Published
  • gratis
  • Background: Low tidal volume (VT) during anesthesia minimizes lung injury but may be associated to a decrease in functional lung volume impairing lung mechanics and efficiency. Lung recruitment (RM) can restore lung volume but this may critically depend on the post-RM selected PEEP. This study was a randomized, two parallel arm, open study whose primary outcome was to compare the effects on driving pressure of adding a RM to low-VT ventilation, with or without an individualized post-RM PEEP in patients without known previous lung disease during anesthesia. Methods: Consecutive patients scheduled for major abdominal surgery were submitted to low-VT ventilation (6 ml.kg(-1)) and standard PEEP of 5 cmH(2)O (pre-RM, n = 36). After 30 min estabilization all patients received a RM and were randomly allocated to either continue with the same PEEP (RM-5 group, n = 18) or to an individualized open-lung PEEP (OL-PEEP) (Open Lung Approach, OLA group, n = 18) defined as the level resulting in maximal Cdyn during a decremental PEEP trial. We compared the effects on driving pressure and lung efficiency measured by volumetric capnography. Results: OL-PEEP was found at 8 +/- 2 cmH(2)O. 36 patients were included in the final analysis. When compared with pre-RM, OLA resulted in a 22% increase in compliance and a 28% decrease in driving pressure when compared to pre-RM. These parameters did not improve in the RM-5. The trend of the DP was significantly different between the OLA and RM-5 groups (p = 0.002). VDalv/VTalv was significantly lower in the OLA group after the RM (p = 0.035). Conclusions: Lung recruitment applied during low-VT ventilation improves driving pressure and lung efficiency only when applied as an open-lung strategy with an individualized PEEP in patients without lung diseases undergoing major abdominal surgery.

Ämnesord och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Suarez-Sipmann, Fernando (författare)
  • Tusman, Gerardo (författare)
  • Leon, Irene (författare)
  • Romero, Esther (författare)
  • Gracia, Estefania (författare)
  • Mugarra, Ana (författare)
  • Arocas, Blanca (författare)
  • Pozo, Natividad (författare)
  • Soro, Marina (författare)
  • Belda, Francisco J. (författare)
  • Uppsala universitetMedicinska och farmaceutiska vetenskapsområdet (utgivare)

Sammanhörande titlar

  • Del av/supplement till:channel record
  • Ingår i:VärdpublikationPLoS ONE12:51932-6203

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  • PLoS ONE (Sök värdpublikationen i LIBRIS)

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