Ventilation with increased apparatus dead space vs positive end-expiratory pressure : Effects on gas exchange and circulation during anesthesia in a randomized clinical study
(2014) In AANA Journal 82(2). p.114-120- Abstract
Atelectasis formation can be reduced by positive endexpiratory 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 H2O (PEEP, 15 patients) or increased tidal volumes achieved with larger... (More)
Atelectasis formation can be reduced by positive endexpiratory 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 H2O (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.
(Less)
- author
- Enekvist, Bruno LU ; Bodelsson, Mikael LU ; Chew, Michelle LU and Johansson, Anders LU
- organization
- publishing date
- 2014-01-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cardiac output, Pulmonary gas exchange, Sevoflurane
- in
- AANA Journal
- volume
- 82
- issue
- 2
- pages
- 7 pages
- publisher
- AANA Publishing Inc.
- external identifiers
-
- pmid:24902453
- scopus:84898037590
- ISSN
- 0094-6354
- language
- English
- LU publication?
- yes
- id
- 788a27a7-8d82-4464-a6f4-768fe5d89526
- date added to LUP
- 2019-05-21 05:31:30
- date last changed
- 2025-01-09 09:59:38
@article{788a27a7-8d82-4464-a6f4-768fe5d89526, abstract = {{<p>Atelectasis formation can be reduced by positive endexpiratory 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 H<sub>2</sub>O (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.</p>}}, author = {{Enekvist, Bruno and Bodelsson, Mikael and Chew, Michelle and Johansson, Anders}}, issn = {{0094-6354}}, keywords = {{Cardiac output; Pulmonary gas exchange; Sevoflurane}}, language = {{eng}}, month = {{01}}, number = {{2}}, pages = {{114--120}}, publisher = {{AANA Publishing Inc.}}, series = {{AANA Journal}}, title = {{Ventilation with increased apparatus dead space vs positive end-expiratory pressure : Effects on gas exchange and circulation during anesthesia in a randomized clinical study}}, volume = {{82}}, year = {{2014}}, }