Journal article
Respiratory System Mechanics During Low Versus High Positive End-Expiratory Pressure in Open Abdominal Surgery: A Substudy of PROVHILO Randomized Controlled Trial
Anesthesia and analgesia, Vol.126(1), pp.143-149
01/2018
DOI: 10.1213/ANE.0000000000002192
PMCID: PMC6696998
PMID: 28632529
Abstract
In the 2014 PROtective Ventilation using HIgh versus LOw positive end-expiratory pressure (PROVHILO) trial, intraoperative low tidal volume ventilation with high positive end-expiratory pressure (PEEP = 12 cm H2O) and lung recruitment maneuvers did not decrease postoperative pulmonary complications when compared to low PEEP (0-2 cm H2O) approach without recruitment breaths. However, effects of intraoperative PEEP on lung compliance remain poorly understood. We hypothesized that higher PEEP leads to a dominance of intratidal overdistension, whereas lower PEEP results in intratidal recruitment/derecruitment (R/D). To test our hypothesis, we used the volume-dependent elastance index %E2, a respiratory parameter that allows for noninvasive and radiation-free assessment of dominant overdistension and intratidal R/D. We compared the incidence of intratidal R/D, linear expansion, and overdistension by means of %E2 in a subset of the PROVHILO cohort.
In 36 patients from 2 participating centers of the PROVHILO trial, we calculated respiratory system elastance (E), resistance (R), and %E2, a surrogate parameter for intratidal overdistension (%E2 > 30%) and R/D (%E2 < 0%). To test the main hypothesis, we compared the incidence of intratidal overdistension (primary end point) and R/D in higher and lower PEEP groups, as measured by %E2.
E was increased in the lower compared to higher PEEP group (18.6 [16…22] vs 13.4 [11.0…17.0] cm H2O·L; P < .01). %E2 was reduced in the lower PEEP group compared to higher PEEP (-15.4 [-28.0…6.5] vs 6.2 [-0.8…14.0] %; P < .05). Intratidal R/D was increased in the lower PEEP group (61% vs 22%; P = .037). The incidence of intratidal overdistension did not differ significantly between groups (6%).
During mechanical ventilation with protective tidal volumes in patients undergoing open abdominal surgery, lung recruitment followed by PEEP of 12 cm H2O decreased the incidence of intratidal R/D and did not worsen overdistension, when compared to PEEP ≤2 cm H2O.
Details
- Title: Subtitle
- Respiratory System Mechanics During Low Versus High Positive End-Expiratory Pressure in Open Abdominal Surgery: A Substudy of PROVHILO Randomized Controlled Trial
- Creators
- Davide D'Antini - From the Department of Anaesthesia and Intensive Care, University of Foggia, Foggia, ItalyRobert Huhle - Department of Anaesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, GermanyJacob Herrmann - Departments of Anesthesia and Biomedical Engineering, University of Iowa, Iowa City, IowaDemet S Sulemanji - Department of Anesthesia, Harvard Medical School, Boston, MassachusettsJun Oto - Department of Anesthesia, Harvard Medical School, Boston, MassachusettsPasquale Raimondo - From the Department of Anaesthesia and Intensive Care, University of Foggia, Foggia, ItalyLucia Mirabella - From the Department of Anaesthesia and Intensive Care, University of Foggia, Foggia, ItalySabrine N T Hemmes - Department of Intensive Care and Laboratory for Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center at the University of Amsterdam, Amsterdam, the NetherlandsMarcus J Schultz - Department of Intensive Care and Laboratory for Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center at the University of Amsterdam, Amsterdam, the NetherlandsPaolo Pelosi - Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino IST, University of Genoa, Genoa, ItalyDavid W Kaczka - Departments of Anesthesia, Biomedical Engineering, and Radiology, University of Iowa, Iowa City, IowaMarcos Francisco Vidal Melo - Department of Anesthesia, Harvard Medical School, Boston, MassachusettsMarcelo Gama de Abreu - Department of Anaesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, GermanyGilda Cinnella - From the Department of Anaesthesia and Intensive Care, University of Foggia, Foggia, ItalyEuropean Society of Anaesthesiology and the PROtective VEntilation Network
- Resource Type
- Journal article
- Publication Details
- Anesthesia and analgesia, Vol.126(1), pp.143-149
- DOI
- 10.1213/ANE.0000000000002192
- PMID
- 28632529
- PMCID
- PMC6696998
- NLM abbreviation
- Anesth Analg
- ISSN
- 0003-2999
- eISSN
- 1526-7598
- Publisher
- United States
- Grant note
- R34 HL123438 / NHLBI NIH HHS UM1 HL108724 / NHLBI NIH HHS
- Language
- English
- Date published
- 01/2018
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Anesthesia
- Record Identifier
- 9984006489202771
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