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Ventilation with increased apparatus dead space vs positive end-expiratory pressure : Effects on gas exchange and circulation during anesthesia in a randomized clinical study

Enekvist, Bruno LU ; Bodelsson, Mikael LU ; Chew, Michelle LU and Johansson, Anders LU (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.

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author
; ; and
organization
publishing date
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
  • scopus:84898037590
  • pmid:24902453
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
2021-08-11 01:09:18
@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 &lt; .05). Cardiac output decreased significantly less in the DS group compared with the PEEP group (5% and 33%, respectively; P &lt; .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},
  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},
}