Individualized positive end-expiratory pressure in obese patients during general anaesthesia: a randomized controlled clinical trial using electrical impedance tomography

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dc.creatorChristian Nestler
dc.creatorPhilipp Simon
dc.creatorDavid Petroff
dc.creatorSören Hammermüller
dc.creatorD. Kamrath
dc.creatorSamuel Johannes Wolf
dc.creatorArne Dietrich
dc.creatorLuciana Moisés Camilo
dc.creatorAlessandro Beda
dc.creatorAlysson Roncally Silva Carvalho
dc.creatorAntonio Giannella-Neto
dc.creatorAndreas Wolfgang Reske
dc.creatorHermann Wrigge
dc.date.accessioned2025-04-03T14:55:26Z
dc.date.accessioned2025-09-09T00:26:59Z
dc.date.available2025-04-03T14:55:26Z
dc.date.issued2017
dc.identifier.doihttps://doi.org/10.1093/bja/aex192
dc.identifier.issn0007-0912
dc.identifier.urihttps://hdl.handle.net/1843/81261
dc.languageeng
dc.publisherUniversidade Federal de Minas Gerais
dc.relation.ispartofBritish journal of anaesthesia
dc.rightsAcesso Restrito
dc.subjectTestes de função respiratória DeCS
dc.subjectHarmônicos (Ondas elétricas)
dc.subjectImpedância (Eletricidade)
dc.subject.otherbariatric surgery; lung volume measurements; morbid; obesity; positive-pressure respiration; pulmonary gas exchange
dc.titleIndividualized positive end-expiratory pressure in obese patients during general anaesthesia: a randomized controlled clinical trial using electrical impedance tomography
dc.typeArtigo de periódico
local.citation.epage12
local.citation.spage1
local.citation.volume119
local.description.resumoBackground: General anaesthesia leads to atelectasis, reduced end-expiratory lung volume (EELV), and diminished arterial oxygenation in obese patients. We hypothesized that a combination of a recruitment manoeuvre (RM) and individualized positive end-expiratory pressure (PEEP) can avoid these effects. Methods: Patients with a BMI ≥35 kg m -2 undergoing elective laparoscopic surgery were randomly allocated to mechanical ventilation with a tidal volume of 8 ml kg -1 predicted body weight and (i) an RM followed by individualized PEEP titrated using electrical impedance tomography (PEEP IND ) or (ii) no RM and PEEP of 5 cm H 2 O (PEEP 5 ). Gas exchange, regional ventilation distribution, and EELV (multiple breath nitrogen washout method) were determined before, during, and after anaesthesia. The primary end point was the ratio of arterial partial pressure of oxygen to inspiratory oxygen fraction ( P aO 2 / F iO 2 ). Results: For PEEP IND ( n =25) and PEEP 5 ( n =25) arms together, P aO 2 / F iO 2 and EELV decreased by 15 kPa [95% confidence interval (CI) 11-20 kPa, P <0.001] and 1.2 litres (95% CI 0.9-1.6 litres, P <0.001), respectively, after intubation. Mean ( sd ) PEEP IND was 18.5 (5.6) cm H 2 O. In the PEEP IND arm, P aO 2 / F iO 2 before extubation was 23 kPa higher (95% CI 16-29 kPa; P <0.001), EELV was 1.8 litres larger (95% CI 1.5-2.2 litres; P <0.001), driving pressure was 6.7 cm H 2 O lower (95% CI 5.4-7.9 cm H 2 O; P <0.001), and regional ventilation was more equally distributed than for PEEP 5 . After extubation, however, these differences between the arms vanished. Conclusions: In obese patients, an RM and higher PEEP IND restored EELV, regional ventilation distribution, and oxygenation during anaesthesia, but these differences did not persist after extubation. Therefore, lung protection strategies should include the postoperative period.
local.publisher.countryBrasil
local.publisher.departmentENG - DEPARTAMENTO DE ENGENHARIA ELETRÔNICA
local.publisher.initialsUFMG
local.url.externahttps://pubmed.ncbi.nlm.nih.gov/29045567/

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