Prevention of atelectasis during general anaesthesia

Rothen, Hans Ulrich; Sporre, Bengt; Engberg, G.; Wegenius, G.; Reber, A.; Hedenstierna, Göran

doi:10.1016/s0140-6736(95)92595-3

Cited by 340 publications

(225 citation statements)

References 23 publications

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“….............................................................................................................................................................................................................. ................................................................................................................................................................................................................... ventilatory cycle, the extent depending on the relationship between the pulmonary condition and the ventilator setting [11,17,26,29,48]. Lung consolidation in the ICU is not only caused by high F i O 2 and gravitational forces as during anaesthesia, but also by surfactant dysfunction and alveolar flooding due to an altered vascular barrier [49,50] [12,[51][52][53][54][55][56].…”

Section: Human Studiesmentioning

confidence: 99%

Lung recruitment during mechanical positive pressure ventilation in the PICU: what can be learned from the literature?

Halbertsma¹,

Hoeven

2005

Anaesthesia

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Summary A literature review was conducted to assess the evidence for recruitment manoeuvres used in conventional mechanical positive pressure ventilation. A total of 61 studies on recruitment manoeuvres were identified: 13 experimental, 31 ICU, 6 PICU and 12 anaesthesia studies. Recruitment appears to be a continuous process during inspiration and expiration and is determined by peak inspiratory pressure (PIP) and positive end expiratory pressure (PEEP). Single or repeated recruitment manoeuvres may result in a statistically significant increase in oxygenation; however, this is short lasting and clinically irrelevant, especially in late ARDS and pneumonia. Temporary PIP elevation may be effective but only after PEEP loss (for example disconnection and tracheal suctioning). Continuous PEEP elevation and prone positioning can increase Pao2 significantly. Adverse haemodynamic or barotrauma effects are reported in various studies. No data exist on the effect of recruitment manoeuvres on mortality, morbidity, length of stay or duration of mechanical ventilation. Although recruitment manoeuvres can improve oxygenation, they can potentially increase lung injury, which eventually determines outcome. Based on the presently available literature, prone position and sufficient PEEP as part of a lung protective ventilation strategy seem to be the safest and most effective recruitment manoeuvres. As paediatric physiology is essentially different from adult, paediatric studies are needed to determine the role of recruitment manoeuvres in the PICU.

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Section: Human Studiesmentioning

confidence: 99%

Lung recruitment during mechanical positive pressure ventilation in the PICU: what can be learned from the literature?

Halbertsma¹,

Hoeven

2005

Anaesthesia

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“…Já com oxigênio a 30%, o shunt aumenta somente 2,1%, com uma área mínima de atelectasia de 0,2cm 2 (ROTHEN et al, 1996). Na ausência da pré-oxigenação, o colapso pulmonar não tem sido observado logo após a indução da anestesia; embora, quando FiO 2 é aumentada para 1,0 depois da intubação, a atelectasia torna-se um achado frequente (ROTHEN et al, 1995b). O fato de o O 2 induzir colapsos alveolares não está restrito apenas à indução, pois aumentos de FiO 2 ao final da cirurgia e antes da extubação podem causar atelectasia adicional (BENOÎT et al, 2002 (MAGNUSSON & SPAHN, 2003).…”

Section: Fatores Relacionados a áReas De Atelectasiaunclassified

“…Ressalta-se que, juntamente com FiO 2, a composição do gás a ser administrado tem papel importante na contribuição da formação de áreas de atelectasia e na alteração da relação ventilação/ perfusão (ROTHEN et al, 1995b). Em cães, quando se utiliza uma mistura de oxigênio e óxido nitroso com FiO 2 >0,3, a taxa de transferência de gás de um pulmão não ventilado é mais rápida que com a utilização de oxigênio a 100% (JOYCE et al,1996).…”

Section: Fatores Relacionados a áReas De Atelectasiaunclassified

Atelectasia pulmonar em cães durante anestesia geral

Lopes

Nunes

2009

Cienc. Rural

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“…In recent years at the end of cardiopulmonary bypass (CPB) surgery and before patient extubation, alveolar recruitment manoeuvres were shown to have some benefit on post-surgical hypoxia and allowed an earlier extubation in the treated group [5,15,18,22,[26][27][28]. The total vital capacity manoeuvre (TVCM) is standardized and is the most commonly used.…”

Section: Introductionmentioning

confidence: 99%

“…It consists of inflating the lungs for 15 seconds' duration and maintaining the airway pressure to a level of 40 cm H 2 O [29]. The studies were restricted by the limited number of patients and short term benefits gained [5,15,27,28]. Minkovich et Coll showed that two consecutive recruitment manoeuvres result in a better arterial oxygenation extending from the immediate postoperative period to approximately 24 hours after surgery [26].…”

Section: Introductionmentioning

confidence: 99%

Single or repetitive lung recruitment manoeuvres after cardiac valve replacement surgery

Riachy¹,

Ibrahim²,

Sleilaty³

et al. 2017

Lung Breath J

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Cardiopulmonary bypass surgery has been implicated in causing atelectasis; a major cause of intrapulmonary shunting and hypoxemia postoperatively. This study investigated if repetitive lung recruitment manoeuvres (RRM), before and after extubation, could reduce intrapulmonary shunting for a longer period post-extubation than only one standardized recruitment manoeuvre (SRM), Forty cardiac valve replacement patients were randomised after SRM into two groups: RRM group (n=20): Total vital capacity manoeuvre at surgery end and repeated every 4 hours until extubation; SC group (n=20): Standard care with SRM. Intrapulmonary shunts (Qs/Qt) were measured after anaesthesia induction, at surgery termination and every 4 hours until 24 hours post-extubation. Time to extubation was recorded. Lung function was measured every 12 hours until discharge.A 24 hour post-extubation ANOVA showed no Qs/Qt significant differences between RRM and SC group (4.5 ± 3.3% and 5.3 ± 2.4%). At surgery end, Qs/Qt increased in RRM group (7.3 ± 3.2% to 13.5 ± 3.7%; p<10-3) but was significantly less (p<0.02) compared to SC group (7.3 ± 3.7% to 16.1 ± 6%; p<10-3). Time to extubation was 8.8 ± 4.2 h in RRM group versus 10.4 ± 4.3 h SC group (p<0.2, ns). No significant difference in vital capacity was seen in the RRM group (3.17 ± 1.2 to 1.9 ± 1 l) compared to SC group (3.4 ± 0.8 to 2.1 ± 0.9 l).In valve replacement surgery, RRM is only beneficial in the short-term period and does not assure a better intrapulmonary shunt benefit than one SRM applied at the end of surgery.

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Prevention of atelectasis during general anaesthesia

Cited by 340 publications

References 23 publications

Lung recruitment during mechanical positive pressure ventilation in the PICU: what can be learned from the literature?

Lung recruitment during mechanical positive pressure ventilation in the PICU: what can be learned from the literature?

Atelectasia pulmonar em cães durante anestesia geral

Single or repetitive lung recruitment manoeuvres after cardiac valve replacement surgery

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