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Positive end-expiratory pressure improves end-expiratory lung volume but not oxygenation after induction of anaesthesia

Futier, Emmanuel; Constantin, Jean-Michel; Petit, Antoine; Jung, Boris; Kwiatkowski, Fabrice; Duclos, Martine; Jaber, Samir; Bazin, Jean-Etienne

European Journal of Anaesthesiology: June 2010 - Volume 27 - Issue 6 - p 508–513
doi: 10.1097/EJA.0b013e3283398806
Ventilation

Background and objective: Induction of anaesthesia promotes collapse of dependent lung regions in both obese and nonobese patients. We hypothesized that end-expiratory lung volume (EELV) may be more sensitive than oxygenation to evaluate the effects of positive end-expiratory pressure (PEEP) after anaesthesia induction.

Methods: Forty patients (20 nonobese patients and 20 obese patients) were prospectively studied. After anaesthesia induction, PEEP was adjusted in a stepwise fashion [zero end-expiratory pressure (ZEEP), PEEP 5 cmH2O and PEEP 10 cmH2O]. At each step, we measured EELV, static elastance, gas exchange and dead space. Other than changing PEEP, respiratory settings were kept constant throughout.

Results: Anaesthesia induction and ZEEP both lowered EELV by 39% in nonobese patients and 59% in obese patients (both P < 0.05), as well as oxygenation (P < 0.05). Compared with ZEEP, in nonobese patients, PEEP 5 cmH2O and PEEP 10 cmH2O improved EELV (+15 and +40%, respectively, P < 0.01) and elastance but not oxygenation. In obese patients, PEEP 10 cmH2O also improved EELV (49% vs. ZEEP and 30% vs. PEEP 5 cmH2O, P < 0.01), elastance and dead-space fraction, with no effect on oxygenation. PEEP-induced changes of EELV correlated with changes of elastance (r2 = 0.46, P = 0.003), but not with oxygenation.

Conclusion: After induction of anaesthesia, mechanical ventilation with ZEEP is associated with a profound reduction in EELV. PEEP improves efficiently EELV and respiratory mechanics, with no major effect on oxygenation. EELV may be a useful indicator to guide PEEP setting in the operating room.

From the Department of Anaesthesiology and Critical Care, Hotel-Dieu Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand (EF, J-MC, AP, J-EB), Department of Anaesthesiology and Critical Care B (DAR B), Saint-Eloi Hospital, University Hospital of Montpellier, Montpellier (BJ, SJ), Department of Statistics, Centre Jean Perrin (FK) and Department of Physiology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France (MD)

Received 27 January, 2010

Revised 5 March, 2010

Accepted 8 March, 2010

Correspondence to Dr Emmanuel Futier, Pôle Anesthésie-Réanimation, Hôtel-Dieu, CHU de Clermont-Ferrand, Clermont-Ferrand F-63058, France Tel: +33 4 73 750 520; fax: +33 4 73 750 521; e-mail: efutier@chu-clermontferrand.fr

© 2010 European Society of Anaesthesiology