Optimum PEEP During Anesthesia and in Intensive Care is a Compromise but is Better than Nothing

Hedenstierna, Göran

doi:10.5152/tjar.2016.001

Cited by 10 publications

(6 citation statements)

References 15 publications

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“…However, it should not be forgotten that PEEPopt is rather a compromise than a realistic goal due to the heterogenous regional distribution of ventilation and compliance of the lungs. A PEEP that is appropriate in one region may be harmful in another one: in non-dependent lung parts overinflation can occur, in dependent parts atelectasis may develop [53,54]. Maisch et al defined PEEPopt as the PEEP that prevents atelectasis after ARM and minimizes alveolar dead space ventilation without over-distension [55].…”

Section: Discussionmentioning

confidence: 99%

Effects of intraoperative positive end-expiratory pressure optimization on respiratory mechanics and the inflammatory response: a randomized controlled trial

Ruszkai

Kiss

László

et al. 2020

J Clin Monit Comput

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Applying lung protective mechanical ventilation (LPV) during general anaesthesia even in patients with non-injured lungs is recommended. However, the effects of an individual PEEP-optimisation on respiratory mechanics, oxygenation and their potential correlation with the inflammatory response and postoperative complications have not been evaluated have not been compared to standard LPV in patients undergoing major abdominal surgery. Thirty-nine patients undergoing open radical cystectomy were enrolled in this study. In the study group (SG) optimal PEEP was determined by a decremental titration procedure and defined as the PEEP value resulting the highest static pulmonary compliance. In the control group (CG) PEEP was set to 6 cmH2O. Primary endpoints were intraoperative respiratory mechanics and gas exchange parameters. Secondary outcomes were perioperative procalcitonin kinetics and postoperative pulmonary complications. Optimal PEEP levels (median = 10, range: 8-14 cmH2O), PaO2/FiO2 (451.24 ± 121.78 mmHg vs. 404.15 ± 115.87 mmHg, P = 0.005) and static pulmonary compliance (52.54 ± 13.59 ml cmH2O-1 vs. 45.22 ± 9.13 ml cmH2O-1, P < 0.0001) were significantly higher, while driving pressure (8.26 ± 1.74 cmH2O vs. 9.73 ± 4.02 cmH2O, P < 0.0001) was significantly lower in the SG as compared to the CG. No significant intergroup differences were found in procalcitonin kinetics (P = 0.076). Composite outcome results indicated a non-significant reduction of postoperative complications in the SG. Intraoperative PEEP-optimization resulted in significant improvement in gas exchange and pulmonary mechanics as compared to standard LPV. Whether these have any effect on short and long term outcomes require further investigations. Trial registration: Clinicaltrials.gov, identifier: NCT02931409.

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Section: Discussionmentioning

confidence: 99%

Effects of intraoperative positive end-expiratory pressure optimization on respiratory mechanics and the inflammatory response: a randomized controlled trial

Ruszkai

Kiss

László

et al. 2020

J Clin Monit Comput

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“…Based on these studies, PEEP has been suggested to both improve oxygenation and keep the lungs open in anesthetized patients if the operation lasts for more than two hours. Nevertheless, if the anesthesia continues for less than two hours, FEEP is appropriate only for keeping the lungs open rather than improving oxygenation ( 1 ). Accordingly, applying PEEP is superior to ZEEP in anesthetized patients to avoid postoperative atelectasis.…”

mentioning

confidence: 99%

Global Optimal PEEP for Anesthetized Patients

Mahmoodpoor

Golzari

2017

Anesth Pain Med

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“…A utilização de V T baixo tem sido aceita de modo consensual como parte das estratégias protetoras, mas o ajuste da PEEP permanece controverso (27,30) . Há duas abordagens distintas, uma que preconiza uso da PEEP para abrir e manter o pulmão aberto e outra que preconiza o uso de PEEP baixa com "colapso permissivo" (42)(43)(44)(45) . Autores que defendem a segunda estratégia justificam que uma PEEP maior não protege o pulmão e pode trazer alterações hemodinâmicas (49) .…”

Section: Discussionunclassified

“…Os estudos que avaliam a PEEP no intraoperatório geralmente utilizam um valor arbitrário, não individualizado (42)(43)(44)(45) . Erlansddon et al (46) , ao contrário, …”

Section: Otimização Da Ventilação Mecânica No Intraoperatório De Modounclassified

Efeitos interativos da pressão expiratória final positiva (PEEP) e da fração inspirada de oxigênio (FIO2) no colapso pulmonar durante anestesia geral em modelo experimental suíno

Melo¹

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, pela oportunidade de ter "pertencido a família LIM" e sobretudo por nos transmitir algo que vai além do conhecimento, o entusiasmo pela "verdade científica". Ao Dr. Carlos Carvalho, pela chance de ter concluído um grande sonho.Ao Mauro Tucci, muito obrigado "Maurão" pela amizade, apoio, paciência e inestimável ajuda... desde os tempos da "Bronco"!!! ...pessoa de bom coração sempre é recompensada!!! Beraldo, Caio, Miyuki e Bruno pela grande ajuda nos experimentos!! Sem a ajuda de vocês esta "obra" não teria se concretizado.A Susi, por ter me acolhido no LIM e pelo apoio nos meus experimentos.A Neide, pelo carinho.A Otília, Guilherme, Silvia e Ozires por toda colaboração.A todos meus contemporâneos do LIM, Edu, Fabio, Cris, Tati, Vini, Roberta, Hirota, Takeshi, Rollin, Andréia, Nadja, pela convivência enriquecedora.A todos meus professores, aos meus "Mestres" da FM UFMG, aos meus preceptores da Pneumologia do HJK.

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Optimum PEEP During Anesthesia and in Intensive Care is a Compromise but is Better than Nothing

Cited by 10 publications

References 15 publications

Effects of intraoperative positive end-expiratory pressure optimization on respiratory mechanics and the inflammatory response: a randomized controlled trial

Effects of intraoperative positive end-expiratory pressure optimization on respiratory mechanics and the inflammatory response: a randomized controlled trial

Global Optimal PEEP for Anesthetized Patients

Efeitos interativos da pressão expiratória final positiva (PEEP) e da fração inspirada de oxigênio (FIO2) no colapso pulmonar durante anestesia geral em modelo experimental suíno

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