Recruitment Maneuvers and Higher PEEP, the So-Called Open Lung Concept, in Patients with ARDS

Zee, Philip van der; Gommers, Diederik

doi:10.1007/978-3-030-06067-1_5

Cited by 8 publications

(10 citation statements)

References 33 publications

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“…Although a PEEP of 5 cmH 2 O in our study has been reported in a previous study, a higher PEEP may be much more beneficial for reducing atelectasis formation, as has been recommended by some researchers [41]. RM combined with PEEP was also beneficial for reducing atelectrauma [42], but it was only performed in OLV in our study. This may explain the high occurrence of atelectasis in the non-VATS group.…”

Section: Discussionsupporting

confidence: 48%

Feasibility and efficacy of lung ultrasound to investigate pulmonary complications in patients who developed postoperative Hypoxaemia-a prospective study

et al. 2020

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Background: Postoperative pulmonary complications (PPCs) and hypoxaemia are associated with morbidity and mortality. We aimed to evaluate the feasibility and efficacy of lung ultrasound (LUS) to diagnose PPCs in patients suffering from hypoxaemia after general anaesthesia and compare the results to those of thoracic computed tomography (CT). Methods: Adult patients who received general anaesthesia and suffered from hypoxaemia in the postanaesthesia care unit (PACU) were analysed. Hypoxaemia was defined as an oxygen saturation measured by pulse oximetry (SPO 2) less than 92% for more than 30 s under ambient air conditions. LUS was performed by two trained anaesthesiologists once hypoxaemia occurred. After LUS examination, each patient was transported to the radiology department for thoracic CT scan within 1 h before returning to the ward. Results: From January 2019 to May 2019, 113 patients (61 men) undergoing abdominal surgery (45 patients, 39.8%), video-assisted thoracic surgery (31 patients, 27.4%), major orthopaedic surgery (17 patients, 15.0%), neurosurgery (10 patients, 8.8%) or other surgery (10 patients, 8.8%) were included. CT diagnosed 327 of 1356 lung zones as atelectasis, while LUS revealed atelectasis in 311 of the CT-confirmed zones. Pneumothorax was detected by CT scan in 75 quadrants, 72 of which were detected by LUS. Pleural effusion was diagnosed in 144 zones on CT scan, and LUS detected 131 of these zones. LUS was reliable in diagnosing atelectasis (sensitivity 98.0%, specificity 96.7% and diagnostic accuracy 97.2%), pneumothorax (sensitivity 90.0%, specificity 98.9% and diagnostic accuracy 96.7%) and pleural effusion (sensitivity 92.9%, specificity 96.0% and diagnostic accuracy 95.1%). Conclusions: Lung ultrasound is feasible, efficient and accurate in diagnosing different aetiologies of postoperative hypoxia in healthy-weight patients in the PACU.

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Section: Discussionsupporting

confidence: 48%

Feasibility and efficacy of lung ultrasound to investigate pulmonary complications in patients who developed postoperative Hypoxaemia-a prospective study

et al. 2020

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“…[39][40][41] Although a PEEP of 5 cmH 2 O in our study has been reported in a previous study, a higher PEEP may be much more bene cial for reducing atelectasis formation, as has been recommended by some researchers. 42 RM combined with PEEP was also bene cial for reducing atelectrauma 43 , but it was only performed in OLV in our study. This may explain the high occurrence of atelectasis in the non-VATS group.…”

Section: Discussionmentioning

confidence: 78%

Feasibility and Efficacy of Lung Ultrasound to Investigate Pulmonary Complications in Patients Who Developed Postoperative Hypoxaemia-A Prospective Study

Xie

Sun

You

et al. 2020

Preprint

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Background: Postoperative pulmonary complications (PPCs) and hypoxaemia is associated with morbidity and mortality. We aim to evaluate the feasibility and efficacy of lung ultrasound (LUS) to diagnose PPCs in patients suffering from hypoxemia after general anesthesia and compare the results to those of thoracic computed tomography (CT). Methods: Adult patients who received general anesthesia and suffered from hypoxaemia in the postanaesthesia care unit (PACU) were analyzed. Hypoxaemia was defined as an oxygen saturation measured by pulse oximetry (SPO 2 ) less than 92% for more than 30 seconds under ambient air conditions. LUS was performed by two trained anaesthesiologists once hypoxaemia occurred. After LUS examination, each patient was transported to the radiology department for thoracic CT scan within 1 hour before returning to the ward. Results: From January 2019 to May 2019, 113 patients (61 men) undergoing abdominal surgery (45 patients, 39.8%), video-assisted thoracic surgery (31 patients, 27.4%), major orthopaedic surgery (17 patients, 15.0%), neurosurgery (10 patients, 8.8%) or other surgery (10 patients, 8.8%) were included. CT diagnosed 327 of 1356 lung zones as atelectasis, while LUS revealed atelectasis in 311 of the CT-confirmed zones. Pneumothorax was detected by CT scan in 75 quadrants, 72 of which were detected by LUS. Pleural effusion was diagnosed in 144 zones on CT scan, and LUS detected 131 of these zones. LUS was reliable in diagnosing atelectasis (sensitivity 98.0%, specificity 96.7% and diagnostic accuracy 97.2%), pneumothorax (sensitivity 90.0%, specificity 98.9% and diagnostic accuracy 96.7%) and pleural effusion (sensitivity 92.9%, specificity 96.0% and diagnostic accuracy 95.1%). Conclusions: Lung ultrasound is feasible, efficient and accurate in diagnosing different aetiologies of postoperative hypoxia in healthy-weight patients in the PACU.

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“…ARDS causes atelectasis, interfering with effective oxygenation and ventilation. The 'open lung concept' is a theoretical solution that relies on recruitment maneuvers to keep the lung open with PEEP while using low tidal volumes (Vt) to avoid barotrauma 27 . A common recommendation is ventilation with 6 mL/ kg-1 of the predicted body weight with a maximum plateau pressure (Pplat) of 30 cmH2O and a driving pressure of <15 cmH 2 O (figure 3) 28,29 .…”

Section: Mechanical Ventilation Strategies In Covid-19 Related Ardsmentioning

confidence: 99%

Management of Acute Respiratory Distress Syndrome in COVID-19 Patients

Segers¹,

Hadzic²,

Boxstael³

et al. 2022

Acta Anaest Belg

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Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterized by an acute, diffuse inflammation leading to pulmonary edema and hypoxemia. The pathophysiology of the lung failure in COVID- 19 ARDS is a combination of the viral infection and the immune response of the host. ARDS due to COVID-19 appears to be similar to the non-COVID-19 ARDS, with exception of hypercoagulability. The mortality due to ARDS remains high and the treatment focuses on supportive measures, such as lung-protective ventilation strategy with small tidal volumes, low driving pressures and PEEP-titration, early consideration of prone positioning and a restrictive fluid management. Oxygen should be titrated, and permissive hypercapnia might be necessary to achieve lung-protective ventilation. The use of extracorporeal membrane oxygenation (ECMO) in COVID-19 ARDS is restricted as a rescue therapy in patients who remain hypoxemic. ECMO should be reserved to experienced ECMO centers. Prophylactic anticoagulant therapy is indicated to reduce the formation of thrombi in the microcirculation of organs, especially in the pulmonary microvasculature. Steroids may reduce the host’s immune response and improve mortality in patients requiring oxygen supplementation or invasive ventilation.

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Recruitment Maneuvers and Higher PEEP, the So-Called Open Lung Concept, in Patients with ARDS

Abstract: The pathophysiology of ARDS and VILI The pathophysiology of ARDS is based on the triad of alveolar-capillary membrane injury, high-permeability (alveolar) edema and inflammation [10]. Histologically

Cited by 8 publications

References 33 publications

Feasibility and efficacy of lung ultrasound to investigate pulmonary complications in patients who developed postoperative Hypoxaemia-a prospective study

Feasibility and efficacy of lung ultrasound to investigate pulmonary complications in patients who developed postoperative Hypoxaemia-a prospective study

Feasibility and Efficacy of Lung Ultrasound to Investigate Pulmonary Complications in Patients Who Developed Postoperative Hypoxaemia-A Prospective Study

Management of Acute Respiratory Distress Syndrome in COVID-19 Patients

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