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Effects of an open lung ventilatory strategy on lung gas exchange during laparoscopic surgery.

Authors
  • Peyton, Philip J1, 2
  • Aitken, Sarah2
  • Wallin, Mats3
  • 1 Department of Anaesthesia, University of Melbourne, Melbourne, Australia. , (Australia)
  • 2 Department of Critical Care, University of Melbourne, Melbourne, Australia. , (Australia)
  • 3 Karolinska Institute, Department of Physiology and Pharmacology, Section of Anesthesiology and Intensive Care, Stockholm, Sweden. , (Sweden)
Type
Published Article
Journal
Anaesthesia and intensive care
Publication Date
Jul 01, 2022
Volume
50
Issue
4
Pages
281–288
Identifiers
DOI: 10.1177/0310057X211047602
PMID: 34871514
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

In general anaesthesia, early collapse of poorly ventilated lung segments with low alveolar ventilation-perfusion ratios occurs and may lead to postoperative pulmonary complications after abdominal surgery. An 'open lung' ventilation strategy involves lung recruitment followed by 'individualised' positive end-expiratory pressure titrated to maintain recruitment of low alveolar ventilation-perfusion ratio lung segments. There are limited data in laparoscopic surgery on the effects of this on pulmonary gas exchange. Forty laparoscopic bowel surgery patients were randomly assigned to standard ventilation or an 'open lung' ventilation intervention, with end-tidal target sevoflurane of 1% supplemented by propofol infusion. After peritoneal insufflation, stepped lung recruitment was performed in the intervention group followed by maintenance positive end-expiratory pressure of 12-15 cmH2O adjusted to maintain dynamic lung compliance at post-recruitment levels. Baseline gas and blood samples were taken and repeated after a minimum of 30 minutes for oxygen and carbon dioxide and for sevoflurane partial pressures using headspace equilibration. The sevoflurane arterial/alveolar partial pressure ratio and alveolar deadspace fraction were unchanged from baseline and remained similar between groups (mean (standard deviation) control group = 0.754 (0.086) versus intervention group = 0.785 (0.099), P = 0.319), while the arterial oxygen partial pressure/fractional inspired oxygen concentration ratio was significantly higher in the intervention group at the second timepoint (control group median (interquartile range) 288 (234-372) versus 376 (297-470) mmHg in the intervention group, P = 0.011). There was no difference between groups in the sevoflurane consumption rate. The efficiency of sevoflurane uptake is not improved by open lung ventilation in laparoscopy, despite improved arterial oxygenation associated with effective and sustained recruitment of low alveolar ventilation-perfusion ratio lung segments.

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