Ventilation with increased apparatus dead space vs positive end-expiratory pressure : effects on gas exchange and circulation during anesthesia in a randomized clinical study
Atelectasis formation can be reduced by positive end-expiratory pressure (PEEP), but resulting increases in intrathoracic pressure could affect circulation. We have earlier demonstrated that increased tidal volumes with larger apparatus dead space improves oxygenation and sevoflurane uptake. In the present study, we hypothesize that isocapnic ventilation with increased tidal volumes increases oxygen and sevoflurane uptake similar to ventilation with PEEP, but with less impact on cardiac output. Thirty patients, with ASA physical status 1 or 2, scheduled for elective open colon surgery were randomly assigned to be ventilated with either PEEP at 10 cm H20 (PEEP, 15 patients) or increased tidal volumes achieved with larger apparatus dead space but with zero end-expiratory pressure (DS group, 15 patients). Oxygen tension and arterial sevoflurane concentration were significantly higher in the DS group (P < .05). Cardiac output decreased significantly less in the DS group compared with the PEEP group (5% and 33%, respectively; P < .05). Consequently, isocapnic ventilation with increased tidal volumes using apparatus dead space increased oxygen and sevoflurane tensions in arterial blood and preserved cardiac output better than did PEEP.
| Medienart: |
Artikel |
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| Erscheinungsjahr: |
2014 |
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| Erschienen: |
2014 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:82 |
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| Enthalten in: |
AANA journal - 82(2014), 2 vom: 20. Apr., Seite 114-20 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Enekvist, Bruno [VerfasserIn] |
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| Themen: |
38LVP0K73A |
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| Anmerkungen: |
Date Completed 03.07.2014 Date Revised 02.12.2018 published: Print Citation Status MEDLINE |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM238926230 |
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| 100 | 1 | |a Enekvist, Bruno |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Ventilation with increased apparatus dead space vs positive end-expiratory pressure |b effects on gas exchange and circulation during anesthesia in a randomized clinical study |
| 264 | 1 | |c 2014 | |
| 336 | |a Text |b txt |2 rdacontent | ||
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| 500 | |a Date Completed 03.07.2014 | ||
| 500 | |a Date Revised 02.12.2018 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Atelectasis formation can be reduced by positive end-expiratory pressure (PEEP), but resulting increases in intrathoracic pressure could affect circulation. We have earlier demonstrated that increased tidal volumes with larger apparatus dead space improves oxygenation and sevoflurane uptake. In the present study, we hypothesize that isocapnic ventilation with increased tidal volumes increases oxygen and sevoflurane uptake similar to ventilation with PEEP, but with less impact on cardiac output. Thirty patients, with ASA physical status 1 or 2, scheduled for elective open colon surgery were randomly assigned to be ventilated with either PEEP at 10 cm H20 (PEEP, 15 patients) or increased tidal volumes achieved with larger apparatus dead space but with zero end-expiratory pressure (DS group, 15 patients). Oxygen tension and arterial sevoflurane concentration were significantly higher in the DS group (P < .05). Cardiac output decreased significantly less in the DS group compared with the PEEP group (5% and 33%, respectively; P < .05). Consequently, isocapnic ventilation with increased tidal volumes using apparatus dead space increased oxygen and sevoflurane tensions in arterial blood and preserved cardiac output better than did PEEP | ||
| 650 | 4 | |a Comparative Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 7 | |a Anesthetics, Inhalation |2 NLM | |
| 650 | 7 | |a Methyl Ethers |2 NLM | |
| 650 | 7 | |a Sevoflurane |2 NLM | |
| 650 | 7 | |a 38LVP0K73A |2 NLM | |
| 700 | 1 | |a Bodelsson, Mikael |e verfasserin |4 aut | |
| 700 | 1 | |a Chew, Michelle |e verfasserin |4 aut | |
| 700 | 1 | |a Johansson, Anders |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t AANA journal |d 1974 |g 82(2014), 2 vom: 20. Apr., Seite 114-20 |w (DE-627)NLM000064939 |x 2162-5239 |7 nnns |
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