Gerardo Tusman1, Iván Groisman, Felipe E Fiolo, Adriana Scandurra, Jorge Martinez Arca, Gustavo Krumrick, Stephan H Bohm, Fernando Suarez Sipmann. 1. From the Departments of *Anesthesia and †Surgery, Hospital Privado de Comunidad, Mar del Plata, Buenos Aires; ‡Bioengineering Laboratory, Electronic Department, School of Engineering, Mar del Plata University, Mar del Plata, Argentina; §Swisstom AG, Landquart, Switzerland; ‖Department of Surgical Sciences, Clinical Physiology, Uppsala University Hospital, Uppsala, Sweden; and ¶Instituto de Investigación Santinaria, Fundación Jiménez Díaz, IIS-FJD, CIBERES, Madrid, Spain.
Abstract
BACKGROUND: We conducted this study to determine whether pulse oximetry and volumetric capnography (VCap) can determine the opening and closing pressures of lungs of anesthetized morbidly obese patients. METHODS: Twenty morbidly obese patients undergoing laparoscopic bariatric surgery with capnoperitoneum were studied. A lung recruitment maneuver was performed in pressure control ventilation as follows: (1) During an ascending limb, the lungs' opening pressure was detected. After increasing positive end-expiratory pressure (PEEP) from 8 to 16 cm H2O, fraction of inspired oxygen (FIO2) was decreased until pulse oximetric arterial saturation (SpO2) was <92%. Thereafter, end-inspiratory pressure was increased in steps of 2 cm H2O, from 36 to a maximum of 50 cm H2O. The opening pressure was attained when SpO2 exceeded 97%. (2) During a subsequent decreasing limb, the lungs' closing pressure was identified. PEEP was decreased from 22 to 10 cm H2O in steps of 2 cm H2O. The closing pressure was determined as the PEEP value at which respiratory compliance decreased from its maximum value. We continuously recorded lung mechanics, SpO2, and VCap. RESULTS: The lungs' opening pressures were detected at 44 (4) cm H2O (median and interquartile range) and the closing pressure at 14 (2) cm H2O. Therefore, the level of PEEP that kept the lungs without collapse was found to be 16 (3) cm H2O. Using respiratory compliance as a reference, receiver operating characteristic analysis showed that SpO2 (area under the curve [AUC] 0.80 [SE 0.07], sensitivity 0.65, and specificity 0.94), the elimination of CO2 per breath (AUC 0.91 [SE 0.05], sensitivity 0.85, and specificity 0.98), and Bohr's dead space (AUC 0.83 [SE 0.06], sensitivity 0.70, and specificity 0.95] were relatively accurate for detecting lung collapse during the decreasing limb of a recruitment maneuver. CONCLUSIONS: Lung recruitment in morbidly obese patients could be effectively monitored by combining noninvasive pulse oximetry and VCap. SpO2, the elimination of CO2, and Bohr's dead space detected the individual's opening and closing pressures.
BACKGROUND: We conducted this study to determine whether pulse oximetry and volumetric capnography (VCap) can determine the opening and closing pressures of lungs of anesthetized morbidly obesepatients. METHODS: Twenty morbidly obesepatients undergoing laparoscopic bariatric surgery with capnoperitoneum were studied. A lung recruitment maneuver was performed in pressure control ventilation as follows: (1) During an ascending limb, the lungs' opening pressure was detected. After increasing positive end-expiratory pressure (PEEP) from 8 to 16 cm H2O, fraction of inspired oxygen (FIO2) was decreased until pulse oximetric arterial saturation (SpO2) was <92%. Thereafter, end-inspiratory pressure was increased in steps of 2 cm H2O, from 36 to a maximum of 50 cm H2O. The opening pressure was attained when SpO2 exceeded 97%. (2) During a subsequent decreasing limb, the lungs' closing pressure was identified. PEEP was decreased from 22 to 10 cm H2O in steps of 2 cm H2O. The closing pressure was determined as the PEEP value at which respiratory compliance decreased from its maximum value. We continuously recorded lung mechanics, SpO2, and VCap. RESULTS: The lungs' opening pressures were detected at 44 (4) cm H2O (median and interquartile range) and the closing pressure at 14 (2) cm H2O. Therefore, the level of PEEP that kept the lungs without collapse was found to be 16 (3) cm H2O. Using respiratory compliance as a reference, receiver operating characteristic analysis showed that SpO2 (area under the curve [AUC] 0.80 [SE 0.07], sensitivity 0.65, and specificity 0.94), the elimination of CO2 per breath (AUC 0.91 [SE 0.05], sensitivity 0.85, and specificity 0.98), and Bohr's dead space (AUC 0.83 [SE 0.06], sensitivity 0.70, and specificity 0.95] were relatively accurate for detecting lung collapse during the decreasing limb of a recruitment maneuver. CONCLUSIONS: Lung recruitment in morbidly obesepatients could be effectively monitored by combining noninvasive pulse oximetry and VCap. SpO2, the elimination of CO2, and Bohr's dead space detected the individual's opening and closing pressures.
Authors: W Kinnear; L Watson; P Smith; L Johnson; S Burrows; J Colt; M Sovani; A Khanna Journal: Chron Respir Dis Date: 2016-12-06 Impact factor: 2.444
Authors: Carlos Ferrando; Carolina Romero; Gerardo Tusman; Fernando Suarez-Sipmann; Jaume Canet; Rosa Dosdá; Paola Valls; Abigail Villena; Ferran Serralta; Ana Jurado; Juan Carrizo; Jose Navarro; Cristina Parrilla; Jose E Romero; Natividad Pozo; Marina Soro; Jesús Villar; Francisco Javier Belda Journal: BMJ Open Date: 2017-05-29 Impact factor: 2.692
Authors: Carlos Ferrando; Marina Soro; Carmen Unzueta; Jaume Canet; Gerardo Tusman; Fernando Suarez-Sipmann; Julian Librero; Salvador Peiró; Natividad Pozo; Carlos Delgado; Maite Ibáñez; César Aldecoa; Ignacio Garutti; David Pestaña; Aurelio Rodríguez; Santiago García Del Valle; Oscar Diaz-Cambronero; Jaume Balust; Francisco Javier Redondo; Manuel De La Matta; Lucía Gallego; Manuel Granell; Pascual Martínez; Ana Pérez; Sonsoles Leal; Kike Alday; Pablo García; Pablo Monedero; Rafael Gonzalez; Guido Mazzinari; Gerardo Aguilar; Jesús Villar; Francisco Javier Belda Journal: BMJ Open Date: 2017-07-31 Impact factor: 2.692