Respiratory mechanics and mechanical power during low vs. high positive end-expiratory pressure in obese surgical patients - A sub-study of the PROBESE randomized controlled trial
Copyright © 2023 Elsevier Inc. All rights reserved..
STUDY OBJECTIVE: We aimed to characterize intra-operative mechanical ventilation with low or high positive end-expiratory pressure (PEEP) and recruitment manoeuvres (RM) regarding intra-tidal recruitment/derecruitment and overdistension using non-linear respiratory mechanics, and mechanical power in obese surgical patients enrolled in the PROBESE trial.
DESIGN: Prospective, two-centre substudy of the international, multicentre, two-arm, randomized-controlled PROBESE trial.
SETTING: Operating rooms of two European University Hospitals.
PATIENTS: Forty-eight adult obese patients undergoing abdominal surgery.
INTERVENTIONS: Intra-operative protective ventilation with either PEEP of 12 cmH2O and repeated RM (HighPEEP+RM) or 4 cmH2O without RM (LowPEEP).
MEASUREMENTS: The index of intra-tidal recruitment/de-recruitment and overdistension (%E2) as well as airway pressure, tidal volume (VT), respiratory rate (RR), resistance, elastance, and mechanical power (MP) were calculated from respiratory signals recorded after anesthesia induction, 1 h thereafter, and end of surgery (EOS).
MAIN RESULTS: Twenty-four patients were analyzed in each group. PEEP was higher (mean ± SD, 11.7 ± 0.4 vs. 3.7 ± 0.6 cmH2O, P < 0.001) and driving pressure lower (12.8 ± 3.5 vs. 21.7 ± 6.8 cmH2O, P < 0.001) during HighPEEP+RM than LowPEEP, while VT and RR did not differ significantly (7.3 ± 0.6 vs. 7.4 ± 0.8 ml∙kg-1, P = 0.835; and 14.6 ± 2.5 vs. 15.7 ± 2.0 min-1, P = 0.150, respectively). %E2 was higher in HighPEEP+RM than in LowPEEP following induction (-3.1 ± 7.2 vs. -12.4 ± 10.2%; P < 0.001) and subsequent timepoints. Total resistance and elastance (13.3 ± 3.8 vs. 17.7 ± 6.8 cmH2O∙l∙s-2, P = 0.009; and 15.7 ± 5.5 vs. 28.5 ± 8.4 cmH2O∙l, P < 0.001, respectively) were lower during HighPEEP+RM than LowPEEP. Additionally, MP was lower in HighPEEP+RM than LowPEEP group (5.0 ± 2.2 vs. 10.4 ± 4.7 J∙min-1, P < 0.001).
CONCLUSIONS: In this sub-cohort of PROBESE, intra-operative ventilation with high PEEP and RM reduced intra-tidal recruitment/de-recruitment as well as driving pressure, elastance, resistance, and mechanical power, as compared with low PEEP.
TRIAL REGISTRATION: The PROBESE study was registered at www.
CLINICALTRIALS: gov, identifier: NCT02148692 (submission for registration on May 23, 2014).
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 2023 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:92 |
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| Enthalten in: |
Journal of clinical anesthesia - 92(2023) vom: 05. Feb., Seite 111242 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Scharffenberg, Martin [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 24.11.2023 Date Revised 22.12.2023 published: Print-Electronic ClinicalTrials.gov: NCT02148692 Citation Status MEDLINE |
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| doi: |
10.1016/j.jclinane.2023.111242 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 100 | 1 | |a Scharffenberg, Martin |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Respiratory mechanics and mechanical power during low vs. high positive end-expiratory pressure in obese surgical patients - A sub-study of the PROBESE randomized controlled trial |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 24.11.2023 | ||
| 500 | |a Date Revised 22.12.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT02148692 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Elsevier Inc. All rights reserved. | ||
| 520 | |a STUDY OBJECTIVE: We aimed to characterize intra-operative mechanical ventilation with low or high positive end-expiratory pressure (PEEP) and recruitment manoeuvres (RM) regarding intra-tidal recruitment/derecruitment and overdistension using non-linear respiratory mechanics, and mechanical power in obese surgical patients enrolled in the PROBESE trial | ||
| 520 | |a DESIGN: Prospective, two-centre substudy of the international, multicentre, two-arm, randomized-controlled PROBESE trial | ||
| 520 | |a SETTING: Operating rooms of two European University Hospitals | ||
| 520 | |a PATIENTS: Forty-eight adult obese patients undergoing abdominal surgery | ||
| 520 | |a INTERVENTIONS: Intra-operative protective ventilation with either PEEP of 12 cmH2O and repeated RM (HighPEEP+RM) or 4 cmH2O without RM (LowPEEP) | ||
| 520 | |a MEASUREMENTS: The index of intra-tidal recruitment/de-recruitment and overdistension (%E2) as well as airway pressure, tidal volume (VT), respiratory rate (RR), resistance, elastance, and mechanical power (MP) were calculated from respiratory signals recorded after anesthesia induction, 1 h thereafter, and end of surgery (EOS) | ||
| 520 | |a MAIN RESULTS: Twenty-four patients were analyzed in each group. PEEP was higher (mean ± SD, 11.7 ± 0.4 vs. 3.7 ± 0.6 cmH2O, P < 0.001) and driving pressure lower (12.8 ± 3.5 vs. 21.7 ± 6.8 cmH2O, P < 0.001) during HighPEEP+RM than LowPEEP, while VT and RR did not differ significantly (7.3 ± 0.6 vs. 7.4 ± 0.8 ml∙kg-1, P = 0.835; and 14.6 ± 2.5 vs. 15.7 ± 2.0 min-1, P = 0.150, respectively). %E2 was higher in HighPEEP+RM than in LowPEEP following induction (-3.1 ± 7.2 vs. -12.4 ± 10.2%; P < 0.001) and subsequent timepoints. Total resistance and elastance (13.3 ± 3.8 vs. 17.7 ± 6.8 cmH2O∙l∙s-2, P = 0.009; and 15.7 ± 5.5 vs. 28.5 ± 8.4 cmH2O∙l, P < 0.001, respectively) were lower during HighPEEP+RM than LowPEEP. Additionally, MP was lower in HighPEEP+RM than LowPEEP group (5.0 ± 2.2 vs. 10.4 ± 4.7 J∙min-1, P < 0.001) | ||
| 520 | |a CONCLUSIONS: In this sub-cohort of PROBESE, intra-operative ventilation with high PEEP and RM reduced intra-tidal recruitment/de-recruitment as well as driving pressure, elastance, resistance, and mechanical power, as compared with low PEEP | ||
| 520 | |a TRIAL REGISTRATION: The PROBESE study was registered at www | ||
| 520 | |a CLINICALTRIALS: gov, identifier: NCT02148692 (submission for registration on May 23, 2014) | ||
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Intraoperative ventilation | |
| 650 | 4 | |a Lung recruitment | |
| 650 | 4 | |a Mechanical power | |
| 650 | 4 | |a Mechanical ventilation | |
| 650 | 4 | |a Positive end-expiratory pressure | |
| 650 | 4 | |a Respiratory mechanics | |
| 700 | 1 | |a Mandelli, Maura |e verfasserin |4 aut | |
| 700 | 1 | |a Bluth, Thomas |e verfasserin |4 aut | |
| 700 | 1 | |a Simonassi, Francesca |e verfasserin |4 aut | |
| 700 | 1 | |a Wittenstein, Jakob |e verfasserin |4 aut | |
| 700 | 1 | |a Teichmann, Robert |e verfasserin |4 aut | |
| 700 | 1 | |a Birr, Katharina |e verfasserin |4 aut | |
| 700 | 1 | |a Kiss, Thomas |e verfasserin |4 aut | |
| 700 | 1 | |a Ball, Lorenzo |e verfasserin |4 aut | |
| 700 | 1 | |a Pelosi, Paolo |e verfasserin |4 aut | |
| 700 | 1 | |a Schultz, Marcus J |e verfasserin |4 aut | |
| 700 | 1 | |a Gama de Abreu, Marcelo |e verfasserin |4 aut | |
| 700 | 1 | |a Huhle, Robert |e verfasserin |4 aut | |
| 700 | 0 | |a PROBESE-investigators |e verfasserin |4 aut | |
| 700 | 0 | |a Protective Ventilation Network |e verfasserin |4 aut | |
| 700 | 0 | |a Clinical Trials Network of the European Society of Anaesthesiology and Intensive Care |e verfasserin |4 aut | |
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