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  • Ferrando, CarlosHosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain. (author)

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

  • Article/chapterEnglish2017

Publisher, publication year, extent ...

  • 2017-05-11
  • PUBLIC LIBRARY SCIENCE,2017
  • electronicrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:uu-326245
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-326245URI
  • https://doi.org/10.1371/journal.pone.0177399DOI

Supplementary language notes

  • Language:English
  • Summary in:English

Part of subdatabase

Classification

  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • 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.

Added entries (persons, corporate bodies, meetings, titles ...)

  • Suarez-Sipmann, FernandoUppsala universitet,Hedenstiernalaboratoriet,Inst Salud Carlos III, GIBER Enfermedades Resp, Madrid, Spain(Swepub:uu)fersi946 (author)
  • Tusman, GerardoHosp Privado Comunidad Mar Del Plata, Dept Anesthesiol, Mar Del Plata, Buenos Aires, Argentina. (author)
  • Leon, IreneHosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain. (author)
  • Romero, EstherHosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain. (author)
  • Gracia, EstefaniaHosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain. (author)
  • Mugarra, AnaHosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain. (author)
  • Arocas, BlancaHosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain. (author)
  • Pozo, NatividadHosp Clin Univ, INCLIVA Clin Res Inst, Valencia, Spain. (author)
  • Soro, MarinaHosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain. (author)
  • Belda, Francisco J.Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain. (author)
  • Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.Hedenstiernalaboratoriet (creator_code:org_t)

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  • In:PLOS ONE: PUBLIC LIBRARY SCIENCE12:51932-6203

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