Meijuan Qian1, Fen Yang1, Lihong Zhao1, Jun Shen2, Yang Xie1. 1. Department of Anesthesiology, Gusu School, Nanjing Medical University, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital Suzhou 215002, Jiangsu Province, China. 2. Department of Orthopaedic Surgery, Gusu School, Nanjing Medical University, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital Suzhou 215002, Jiangsu Province, China.
Abstract
OBJECTIVE: To investigate the effect of individualized positive end-expiratory pressure (PEEP) titration on intraoperative respiration and circulation in elderly patients undergoing spinal surgery in prone position under general anesthesia. METHODS: We prospectively selected 80 elderly patients (39 males and 41 females) aged over 65 years old, at American Society of Anesthesiologists (ASA) grade II or III, who underwent elective prone spinal surgery under general anesthesia, for this study. These patients were randomly divided into titration group and control group, with 40 cases in each group. PEEP of the titration group was increased from 0 to 20 cmH2O by steps of 2 cmH2O. For the control group, PEEP was constantly at 5 cmH2O and ventilation was maintained throughout the surgery. Dynamic pulmonary compliance (Cdyn) measurements were recorded when each PEEP level was kept for 1 min during titration, and individualized PEEP was determined by maximal Cdyn. MAP (mean arterial pressure), heart rate (HR), and CVP (Central venous pressure) were recorded at the set of prone position (T0), PEEP ventilation for 10 min (T1), 30 min (T2), 60 min (T3), end of surgery (T4), and 20 min after extubation (T5). Mean airway pressure (Pmean) and Cdyn were recorded from T0 to T4. Blood gas analysis was performed from T0 to T5 to calculate intrapulmonary shunt fraction (Qs/Qt) and OI (PaO2/FiO2). The rate of phenylephrine use during mechanical ventilation and the incidence of postoperative pulmonary complications were also recorded. RESULTS: The individualized PEEP obtained by titration for 1 min in the titration group was (12.38±2.67) cmH2O, which was significantly higher than the 5 cmH2O in constant PEEP of the control group (P<0.05). There was no significant difference in MAP, HR, and CVP between the two groups at different time points, and no significant difference was noted in Pmean between the two groups from T0 to T4 (all P>0.05). From T2 to T4, Cdyn was significantly higher, and Qs/Qt was lower in the titration group than those in the control group (all P<0.05). From T2 to T5, the OI in the titration group was significantly higher than that in the control group (P<0.05). The rate of phenylephrine use was significantly higher in the titration group than that in the control group (10 patients (25%) vs. 3 patients (8%), P<0.05). The incidence of postoperative pulmonary complications in the titration group was significantly lower than that in the control group (2 cases (5%) vs. 8 cases (20%), P<0.05). CONCLUSION: Compared with a constant PEEP of 5 cmH2O, intraoperative individualized PEEP titration in elderly patients undergoing spinal surgery in prone position can improve oxygenation, reduce intrapulmonary shunt and postoperative pulmonary complications. (Chinese Clinical Trial Registry, registration number ChiCTR2000040722, https://www.chictr.org.cn). AJTR
OBJECTIVE: To investigate the effect of individualized positive end-expiratory pressure (PEEP) titration on intraoperative respiration and circulation in elderly patients undergoing spinal surgery in prone position under general anesthesia. METHODS: We prospectively selected 80 elderly patients (39 males and 41 females) aged over 65 years old, at American Society of Anesthesiologists (ASA) grade II or III, who underwent elective prone spinal surgery under general anesthesia, for this study. These patients were randomly divided into titration group and control group, with 40 cases in each group. PEEP of the titration group was increased from 0 to 20 cmH2O by steps of 2 cmH2O. For the control group, PEEP was constantly at 5 cmH2O and ventilation was maintained throughout the surgery. Dynamic pulmonary compliance (Cdyn) measurements were recorded when each PEEP level was kept for 1 min during titration, and individualized PEEP was determined by maximal Cdyn. MAP (mean arterial pressure), heart rate (HR), and CVP (Central venous pressure) were recorded at the set of prone position (T0), PEEP ventilation for 10 min (T1), 30 min (T2), 60 min (T3), end of surgery (T4), and 20 min after extubation (T5). Mean airway pressure (Pmean) and Cdyn were recorded from T0 to T4. Blood gas analysis was performed from T0 to T5 to calculate intrapulmonary shunt fraction (Qs/Qt) and OI (PaO2/FiO2). The rate of phenylephrine use during mechanical ventilation and the incidence of postoperative pulmonary complications were also recorded. RESULTS: The individualized PEEP obtained by titration for 1 min in the titration group was (12.38±2.67) cmH2O, which was significantly higher than the 5 cmH2O in constant PEEP of the control group (P<0.05). There was no significant difference in MAP, HR, and CVP between the two groups at different time points, and no significant difference was noted in Pmean between the two groups from T0 to T4 (all P>0.05). From T2 to T4, Cdyn was significantly higher, and Qs/Qt was lower in the titration group than those in the control group (all P<0.05). From T2 to T5, the OI in the titration group was significantly higher than that in the control group (P<0.05). The rate of phenylephrine use was significantly higher in the titration group than that in the control group (10 patients (25%) vs. 3 patients (8%), P<0.05). The incidence of postoperative pulmonary complications in the titration group was significantly lower than that in the control group (2 cases (5%) vs. 8 cases (20%), P<0.05). CONCLUSION: Compared with a constant PEEP of 5 cmH2O, intraoperative individualized PEEP titration in elderly patients undergoing spinal surgery in prone position can improve oxygenation, reduce intrapulmonary shunt and postoperative pulmonary complications. (Chinese Clinical Trial Registry, registration number ChiCTR2000040722, https://www.chictr.org.cn). AJTR
Authors: Davide D'Antini; Robert Huhle; Jacob Herrmann; Demet S Sulemanji; Jun Oto; Pasquale Raimondo; Lucia Mirabella; Sabrine N T Hemmes; Marcus J Schultz; Paolo Pelosi; David W Kaczka; Marcos Francisco Vidal Melo; Marcelo Gama de Abreu; Gilda Cinnella Journal: Anesth Analg Date: 2018-01 Impact factor: 5.108
Authors: Sérgio M Pereira; Mauro R Tucci; Caio C A Morais; Claudia M Simões; Bruno F F Tonelotto; Michel S Pompeo; Fernando U Kay; Paolo Pelosi; Joaquim E Vieira; Marcelo B P Amato Journal: Anesthesiology Date: 2018-12 Impact factor: 7.892
Authors: S Spadaro; D S Karbing; T Mauri; E Marangoni; F Mojoli; G Valpiani; C Carrieri; R Ragazzi; M Verri; S E Rees; C A Volta Journal: Br J Anaesth Date: 2016-06 Impact factor: 9.166
Authors: Carlos Ferrando; Ana Mugarra; Andrea Gutierrez; Jose Antonio Carbonell; Marisa García; Marina Soro; Gerardo Tusman; Francisco Javier Belda Journal: Anesth Analg Date: 2014-03 Impact factor: 5.108
Authors: MiHye Park; Hyun Joo Ahn; Jie Ae Kim; Mikyung Yang; Burn Young Heo; Ji Won Choi; Yung Ri Kim; Sang Hyun Lee; HeeJoon Jeong; Soo Joo Choi; In Sun Song Journal: Anesthesiology Date: 2019-03 Impact factor: 7.892