Comparison of Positive End-Expiratory Pressure of 8 versus 5 cm H<sub>2</sub>O on Outcome After Cardiac Operations

Hansen, Jennifer; Anthony, David G.; Li, Liang; Wheeler, D. M.; Sessler, Daniel I.; Bashour, C. Allen

doi:10.1177/0885066613519571

Cited by 7 publications

(11 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This decline might be due to better levels of arterial oxygenation in ICU after heart surgery in early times by applying 10 cm H 2 O PEEP. Many studies have confirmed that high levels of PEEP can improve arterial oxygenation after heart surgery ( 22 , 23 , 25 ).…”

Section: Discussionmentioning

confidence: 97%

“…Based on the results of a study on the influence of 5 cm H 2 O PEEP and 8 cm H 2 O PEEP after heart surgery, duration of intubation in the ICU had no differences between the two groups ( 25 ). This result is consistent with the present study and the duration was reduced only in the 10 cm H 2 O PEEP group.…”

Section: Discussionmentioning

confidence: 99%

“…This complication in above studies resulting from the use of PEEP was equal to 30 cm of water‏. Some of the articles pointed out the lack of difference among different levels ( 25 - 27 ). Meanwhile, most of the studies examined patients undergoing coronary artery bypass graft surgery, and no studies have been done on other cardiac surgical patients.…”

Section: Introductionmentioning

confidence: 98%

See 2 more Smart Citations

The prophylactic effect of different levels of positive end-expiratory pressure on the incidence rate of atelectasis after cardiac surgery: A Randomized Controlled Trial

Setak-Berenjestanaki

Bagheri-Nesami

Baradari

et al. 2018

Med. J. Islam. Republic Iran

View full text Add to dashboard Cite

Background: The use of positive end-expiratory pressure (PEEP) can have an important role as one of the ways to prevent and treat atelectasis, but it seems that there is still no consensus about its beneficial level. The aim of this study was to determine the effect of different levels of PEEP on the incidence of atelectasis after heart surgery. Methods: This is a double-blind randomized controlled trial that was adopted from a research project recorded in the Iranian Registry of Clinical Trials. This paper is the result of a research project undertaken at Fatemeh Zahra Hospital (Mazandaran Heart Center) in 2015. 180 patients underwent open heart surgery were selected and were divided randomly into three groups: control, PEEP=8, and PEEP=10 (60 in each group). The patients in the two PEEP8 and PEEP10 intervention groups separately received 8 cm H2O and 10 cm H2O PEEP, respectively, 30 minutes after admission to the ICU for 4 hours and then received 5 cm H2O PEEP until extubation. Atelectasis was examined two hours after the extubation and on the third day after surgery. Results: The incidence rates of atelectasis two hours after extubation on the first day of surgery were 22 (36.7%), 20 (33.3%) and 10 (16.7%) patients in the control, PEEP8 and PEEP10 groups, respectively. The differences were statistically significant among the three groups (p=0.035). The incidence rates of atelectasis on the third day after surgery were 39 (65%), 36 (60%) and 21 (35%) patients in the control, PEEP8 and PEEP10 groups, respectively. The differences were also statistically significant among the three groups (p=0.003). Conclusion: The use of 10 cm H2O PEEP can lead to a reduction in the incidence of atelectasis, intubation time at the ICU and length of ICU and hospital stay. Given that this level of PEEP is effective, this method is recommended to be used in postoperative care of patients.

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

See 1 more Smart Citation

The prophylactic effect of different levels of positive end-expiratory pressure on the incidence rate of atelectasis after cardiac surgery: A Randomized Controlled Trial

Setak-Berenjestanaki

Bagheri-Nesami

Baradari

et al. 2018

Med. J. Islam. Republic Iran

View full text Add to dashboard Cite

show abstract

“…Multiple review articles suggested that lung-protective mechanical ventilation (LPV) is beneficial during anesthesia in patients with healthy lungs (9,10), and in individuals with ARDS in intensive care units (ICU) (11). Decades of study have demonstrated that LPV may also reduce VILI (12), via the production of low tidal volumes (TV) (13) and higher positive end-expiratory pressure (PEEP) (14), as well as the performance of regular alveolar recruitment maneuvers (ARM) (15). The effects of different components of ventilation on improving post-operative outcomes in patients with normal lungs following surgery have been broadly explored (16).…”

Section: Introductionmentioning

confidence: 99%

Individualized lung protective ventilation vs. conventional ventilation during general anesthesia in laparoscopic total hysterectomy

Liu

Huang

et al. 2020

Exp Ther Med

View full text Add to dashboard Cite

Laparoscopic total hysterectomy is performed by carbon dioxide insufflation, Trendelenburg position and mechanical ventilation of patients under general anesthesia. However, this may induce pulmonary atelectasis and/or hyperdistention of the lungs. Multiple studies have indicated that mechanical ventilation with the use of low tidal volumes, moderate positive end-expiratory pressure (PEEP) and regular alveolar recruitment maneuvers may improve post-operative outcomes. However, the benefits of an individualized level of PEEP have not been clearly established. In the present study, it was hypothesized that a moderate fixed PEEP may not suit all patients and an individually-titrated PEEP during anesthesia may improve the peri-operative pulmonary oxygenation function. The aim of the present study was to compare the pulmonary oxygenation function and post-operative pulmonary complications (PPCs) in patients receiving individualized lung-protective mechanical ventilation (LPV) vs. conventional ventilation (CV) during laparoscopic total hysterectomy. The present study was a randomized double-blinded clinical trial on 87 patients who were randomly divided to receive CV or protective ventilation (PV). An optimal individualized PEEP value was determined using a static pulmonary compliance-directed PEEP titration procedure. Pulmonary oxygenation function, serum inflammatory factors, including interleukin-8 and Clara cell protein 16, the incidence of PPCs and the post-operative length of stay were also determined. Patients in the PV group exhibited improved pulmonary oxygenation function during and after the operation. The total percentage of PPCs during the first 7 days after surgery was significantly lower in the PV group compared with those in the CV group. In conclusion, as compared to CV, intra-operative individualized LPV significantly improved pulmonary oxygenation function and reduced the incidence of PPCs during the first 7 days after laparoscopic total hysterectomy (Clinical trial registration no. ChiCTR1900027738).

show abstract

“…In VILI the “hit” is intensified in healthy lung by mechanical ventilation even if the least harmful setting was set. 5 Lung protective ventilation and open lung ventilation can reduce VILI 6 with several components of protective ventilation strategy, such as low TV, 7 higher positive-end expiratory pressure (PEEP), 8 and recruitment maneuver. 9 …”

Section: Introductionmentioning

confidence: 99%

The effect of intraoperative lung protective ventilation vs conventional ventilation, on postoperative pulmonary complications after cardiopulmonary bypass

Zamani¹,

Najafi²,

Sehat³

et al. 2017

J Cardiovasc Thorac Res

View full text Add to dashboard Cite

Introduction: This study aimed to evaluate the effects of high positive-end expiratory pressure (PEEP) and low tidal volume (TV) and recruitment maneuver, on postoperative pulmonary complications (PPCs) after coronary artery bypass grafting (CABG) surgery. Methods: This study is a randomized double blind clinical trial on 64 patients who were undergoing CABG surgery, and were randomly divided into two groups of conventional ventilation (C-Vent) with TV of 9 mL/kg and PEEP=0 cm H2O, and lung protective ventilation (P-Vent), with 6 mL/kg TV and PEEP=10 cm H2O with recruitment maneuver every 30 minutes. Measures of PPCs and modified clinical pulmonary infection score (mCPIS), were assessed for the first 24 hours of postoperative time in order to evaluate the pulmonary complications. Results: P-Vent with 31 patients and C-Vent with 30 patients, participated in the stage of data analysis. Demographic, and preoperative laboratory results showed no significant difference between two groups. During surgery, cardiovascular complications were higher in P-Vent group (P = 0.61) but pulmonary complications were higher in C-Vent group (P = 0.26). Extubation time was not significantly different between two groups, and also components of arterial blood gases (ABG) of 24 hours after surgery showed no significant difference between the two groups. Pathologic changes in the chest X-ray (CXR) of 24 hours after surgery, were lower in P-Vent group, but the difference was not significant (P = 0.22). The PPC criteria was less positive in P-Vent (2 patients) vs 9 patients in C-Vent group (P = 0.02) and mCPIS score was significantly lower in P-Vent group (1.2 ± 1.4) than C-Vent group (2 ± 1.6) (P = 0.048). Conclusion: Lung protective strategy during and after cardiac surgery, reduces the postoperative mCPIS in patients undergoing open heart surgery for CABG.

show abstract

Comparison of Positive End-Expiratory Pressure of 8 versus 5 cm H₂O on Outcome After Cardiac Operations

Cited by 7 publications

References 15 publications

The prophylactic effect of different levels of positive end-expiratory pressure on the incidence rate of atelectasis after cardiac surgery: A Randomized Controlled Trial

The prophylactic effect of different levels of positive end-expiratory pressure on the incidence rate of atelectasis after cardiac surgery: A Randomized Controlled Trial

Individualized lung protective ventilation vs. conventional ventilation during general anesthesia in laparoscopic total hysterectomy

The effect of intraoperative lung protective ventilation vs conventional ventilation, on postoperative pulmonary complications after cardiopulmonary bypass

Contact Info

Product

Resources

About

Comparison of Positive End-Expiratory Pressure of 8 versus 5 cm H2O on Outcome After Cardiac Operations

Cited by 7 publications

References 15 publications

The prophylactic effect of different levels of positive end-expiratory pressure on the incidence rate of atelectasis after cardiac surgery: A Randomized Controlled Trial

The prophylactic effect of different levels of positive end-expiratory pressure on the incidence rate of atelectasis after cardiac surgery: A Randomized Controlled Trial

Individualized lung protective ventilation vs. conventional ventilation during general anesthesia in laparoscopic total hysterectomy

The effect of intraoperative lung protective ventilation vs conventional ventilation, on postoperative pulmonary complications after cardiopulmonary bypass

Contact Info

Product

Resources

About

Comparison of Positive End-Expiratory Pressure of 8 versus 5 cm H₂O on Outcome After Cardiac Operations