Physiological effects of the open lung approach during laparoscopic cholecystectomy: focus on driving pressure
| العنوان: | Physiological effects of the open lung approach during laparoscopic cholecystectomy: focus on driving pressure |
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| المؤلفون: | Michele Dambrosio, Lucia Mirabella, Alberto Fersini, Alberto Sciusco, Rosaria Menga, Davide D'Antini, Salvatore Grasso, Gilda Cinnella, Rocco Petta, Michela Rauseo, Luigi Camporota, Antonella Cotoia, Savino Spadaro |
| المصدر: | Minerva Anestesiologica. 84 |
| بيانات النشر: | Edizioni Minerva Medica, 2018. |
| سنة النشر: | 2018 |
| مصطلحات موضوعية: | Male, medicine.medical_treatment, Hemodynamics, Atelectasis, Respiratory physiology, NO, Positive-Pressure Respiration, Laparoscopic cholecystectomy, 03 medical and health sciences, 0302 clinical medicine, Pneumoperitoneum, 030202 anesthesiology, medicine, Humans, Respiratory system, Intraoperative Care, Lung, Respiratory mechanics, Pneumoperitoneum, Laparoscopic cholecystectomy, business.industry, 030208 emergency & critical care medicine, Oxygenation, Middle Aged, respiratory system, medicine.disease, respiratory tract diseases, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Cholecystectomy, Laparoscopic, Anesthesia, Respiratory Mechanics, Female, Cholecystectomy, business, circulatory and respiratory physiology |
| الوصف: | Background During laparoscopy, respiratory mechanics and gas exchange are impaired because of pneumoperitoneum and atelectasis formation. We applied an open lung approach (OLA) consisting in lung recruitment followed by a decremental positive-end expiratory pressure (PEEP) trial to identify the level of PEEP corresponding to the highest compliance of the respiratory system (best PEEP). Our hypothesis was that this approach would improve both lung mechanics and oxygenation without hemodynamic impairment. Methods We studied twenty patients undergoing laparoscopic cholecystectomy. We continuously recorded respiratory mechanics parameters throughout a decremental PEEP trial in order to identify the best PEEP level. Furthermore, lung and chest wall mechanics, respiratory and transpulmonary driving pressures (ΔP), gas exchange and hemodynamics were recorded at three time-points: 1) after pneumoperitoneum induction (TpreOLA); 2) after the application of the OLA (TpostOLA); 3) at the end of surgery, after abdominal deflation (Tend). Results The "best PEEP" level was 8.1±1.3 cmH2O (range 6 to 10 cmH2O), corresponding to the highest compliance of the respiratory system (CRS). This "best PEEP" level corresponded with lowest ΔPL. OLA increased the compliance of the lung and of the chest wall, and decreased ΔPRS and ΔPL. PaO2/FiO2 increased from 299±125 mmHg to 406±101 mmHg (P=0.04). Changes in respiratory mechanics, driving pressures and oxygenation were maintained until Tend. Hemodynamic parameters remained stable throughout the study period. Conclusions In patients undergoing laparoscopic cholecystectomy, the OLA was suitable for bedside PEEP setting, improved lung mechanics and gas exchange without significant adverse hemodynamic effects. |
| تدمد: | 1827-1596 0375-9393 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::067f460f7bdd4b7726a26de0f0d04e1f https://doi.org/10.23736/s0375-9393.17.12042-0 |
| حقوق: | CLOSED |
| رقم الأكسشن: | edsair.doi.dedup.....067f460f7bdd4b7726a26de0f0d04e1f |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 18271596 03759393 |
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