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Hedenstierna, G., Tokics, L., Reinius, H., Rothen, H. U., Östberg, E. & Öhrvik, J. (2020). Higher age and obesity limit atelectasis formation during anaesthesia: an analysis of computed tomography data in 243 subjects. British Journal of Anaesthesia, 124(3), 336-344
Open this publication in new window or tab >>Higher age and obesity limit atelectasis formation during anaesthesia: an analysis of computed tomography data in 243 subjects
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2020 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 124, no 3, p. 336-344Article in journal (Refereed) Published
Abstract [en]

Background: General anaesthesia is increasingly common in elderly and obese patients. Greater age and body mass index (BMI) worsen gas exchange. We assessed whether this is related to increasing atelectasis during general anaesthesia.

Methods: This primary analysis included pooled data from previously published studies of 243 subjects aged 18-78 yr, with BMI of 18-52 kg m(-2). The subjects had no clinical signs of cardiopulmonary disease, and they underwent computed tomography (CT) awake and during anaesthesia before surgery after preoxygenation with an inspired oxygen fraction (FIO2) of >0.8, followed by mechanical ventilation with FIO2 of 0.3 or higher with no PEEP. Atelectasis was assessed by CT.

Results: Atelectasis area of up to 39 cm(2) in a transverse scan near the diaphragm was seen in 90% of the subjects during anaesthesia. The log of atelectasis area was related to a quadratic function of (age+age(2)) with the most atelectasis at similar to 50 yr (r(2)=0.08; P<0.001). Log atelectasis area was also related to a broken-line function of the BMI with the knee at 30 kg m(-2) (r(2)=0.06; P<0.001). Greater atelectasis was seen in the subjects receiving FIO2 of 1.0 than FIO2 of 0.3-0.5 (12.8 vs 8.1 cm(2); P<0.001). A multiple regression analysis, including a quadratic function of age, a broken-line function of the BMI, and dichotomised FIO2 (0.3-0.5/1.0) adjusting for ventilatory frequency, strengthened the association (r(2)= 0.23; P<0.001). PaO2 decreased with both age and BMI.

Conclusions: Atelectasis during general anaesthesia increased with age up to 50 yr and decreased beyond that. Atelectasis increased with BMI in normal and overweight patients, but showed no further increase in obese subjects (BMI >= 30 kg m(-2)). Therefore, greater age and obesity appear to limit atelectasis formation during general anaesthesia.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2020
Keywords
age, atelectasis, general anaesthesia, inspired oxygen, mechanical ventilation, obesity, pulmonary complications
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-407516 (URN)10.1016/j.bja.2019.11.026 (DOI)000514166800045 ()31918847 (PubMedID)
Available from: 2020-03-25 Created: 2020-03-25 Last updated: 2020-03-25Bibliographically approved
Reinius, H., Batista Borges, J., Engström, J., Ahlgren, O., Lennmyr, F., Larsson, A. & Fredén, F. (2019). Optimal PEEP during one-lung ventilation with capnothorax: An experimental study. Acta Anaesthesiologica Scandinavica, 63(2), 222-231
Open this publication in new window or tab >>Optimal PEEP during one-lung ventilation with capnothorax: An experimental study
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2019 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 63, no 2, p. 222-231Article in journal (Refereed) Published
Abstract [en]

Background: One‐lung ventilation (OLV) with induced capnothorax carries the risk of severely impaired ventilation and circulation. Optimal PEEP may mitigate the physiological perturbations during these conditions.

Methods: Right‐sided OLV with capnothorax (16 cm H2O) on the left side was initiated in eight anesthetized, muscle‐relaxed piglets. A recruitment maneuver and a decremental PEEP titration from PEEP 20 cm H2O to zero end‐expiratory pressure (ZEEP) was performed. Regional ventilation and perfusion were studied with electrical impedance tomography and computer tomography of the chest was used. End‐expiratory lung volume and hemodynamics were recorded and.

Results: PaO2 peaked at PEEP 12 cm H2O (49 ± 14 kPa) and decreased to 11 ± 5 kPa at ZEEP (P < 0.001). PaCO2 was 9.5 ± 1.3 kPa at 20 cm H2O PEEP and did not change when PEEP step‐wise was reduced to 12 cm H2O PaCO2. At lower PEEP, PaCO2 increased markedly. The ventilatory driving pressure was lowest at PEEP 14 cm H2O (19.6 ± 5.8 cm H2O) and increased to 38.3 ± 6.1 cm H2O at ZEEP (P < 0.001). When reducing PEEP below 12‐14 cm H2O ventilation shifted from the dependent to the nondependent regions of the ventilated lung (P = 0.003), and perfusion shifted from the ventilated to the nonventilated lung (P = 0.02).

Conclusion: Optimal PEEP was 12‐18 cm H2O and probably relates to capnothorax insufflation pressure. With suboptimal PEEP, ventilation/perfusion mismatch in the ventilated lung and redistribution of blood flow to the nonventilated lung occurred.

Keywords
anesthesia, capnothorax, cardio-thoracic surgery, one lung ventilation, optimal PEEP, PEEP titration
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-268620 (URN)10.1111/aas.13247 (DOI)000454814700012 ()30132806 (PubMedID)
Funder
Swedish Heart Lung Foundation
Note

Title in thesis list of papers: Optimal PEEP during one lung ventilation with capnothorax. An experimental study

Available from: 2015-12-08 Created: 2015-12-08 Last updated: 2019-01-31Bibliographically approved
Engström, J., Bruno, E., Reinius, H., Fröjd, C., Jonsson, H., Sannervik, J. & Larsson, A. (2017). Physiological changes associated with routine nursing procedures in critically ill are common: an observational pilot study. Acta Anaesthesiologica Scandinavica, 61(1), 62-72
Open this publication in new window or tab >>Physiological changes associated with routine nursing procedures in critically ill are common: an observational pilot study
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2017 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 1, p. 62-72Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Nursing procedures that are routinely performed in the intensive care unit (ICU) are assumed to have minimal side effects. However, these procedures may sometimes cause physiological changes that negatively affect the patient. We hypothesized that physiological changes associated with routine nursing procedures in the ICU are common.

METHODS: A clinical observational study of 16 critically ill patients in a nine-bed mixed university hospital ICU. All nursing procedures were observed, and physiological data were collected and subsequently analyzed. Minor physiological changes were defined as minimal changes in respiratory or circulatory variables, and major physiological changes were marked as hyper/hypotension, bradycardia/tachycardia, bradypnea/tachypnea, ventilatory distress, and peripheral blood oxygen desaturation.

RESULTS: In the 16 patients, 668 procedures generated 158 major and 692 minor physiological changes during 187 observational hours. The most common procedure was patient position change, which also generated the majority of the physiological changes. The most common major physiological changes were blood oxygen desaturation, ventilatory distress, and hypotension, and the most common minor changes were arterial pressure alteration, coughing, and increase in respiratory rate.

CONCLUSION: In this pilot study, we examined physiological changes in connection with all regular routine nursing procedures in the ICU. We found that physiological changes were common and sometimes severe.

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-307946 (URN)10.1111/aas.12827 (DOI)000394907900010 ()27813055 (PubMedID)
Funder
Swedish Heart Lung FoundationSwedish Research Council
Available from: 2016-11-23 Created: 2016-11-23 Last updated: 2017-11-29Bibliographically approved
Engström, J., Reinius, H., Ström, J., Bergström, M. F., Larsson, I.-M., Larsson, A. & Borg, T. (2016). Lung complications are common in intensive care treated patients with pelvis fractures: a retrospective cohort study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 24, Article ID 52.
Open this publication in new window or tab >>Lung complications are common in intensive care treated patients with pelvis fractures: a retrospective cohort study
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2016 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 24, article id 52Article in journal (Refereed) Published
Abstract [en]

Background: The incidence of severe respiratory complications in patients with pelvis fractures needing intensive care have not previously been studied. Therefore, the aims of this registry study were to 1) determine the number of ICU patients with pelvis fractures who had severe respiratory complications 2) whether the surgical intervention in these patients is associated with the pulmonary condition and 3) whether there is an association between lung complications and mortality. We hypothesized that acute hypoxic failure (AHF) and acute respiratory distress syndrome (ARDS) 1) are common in ICU treated patients with pelvis fractures, 2) are not related to the reconstructive surgery, or to 3) to mortality. Methods: All patients in the database cohort (n = 112), scheduled for surgical stabilization of pelvis ring and/or acetabulum fractures, admitted to the general ICU at Uppsala University Hospital between 2007 and 2014 for intensive care were included. Results: The incidence of AHF/ARDS was 67 % (75/112 patients), i.e., the percentage of patients that at any period during the ICU stay fulfilled the AHF/ARDS criteria. The incidence of AHF was 44 % and incidence of ARDS was 23 %. The patients with AHF/ARDS had more lung contusions and pneumonia than the patients without AHF/ARDS. Overall, there were no significant changes in oxygenation variables associated with surgery. However, 23 patients with pre-operative normal lung status developed AHF/ARDS in relation to the surgical procedure, whereas 12 patients with AHF/ARDS normalized their lung condition. The patients who developed AHF/ARDS had a higher incidence of lung contusion (P = 0.04) and the surgical stabilization was performed earlier (5 versus 10 days) in these patients (P = 0.03). Conclusions: We found that the incidence of respiratory failure in ICU treated patients with pelvis fractures was high, that the procedure around surgical stabilization seems to be associated with a worsening in the respiratory function in patients with lung contusion, and that mortality was low and was probably not related to the respiratory condition.

Keywords
Acute hypoxic failure, Acute respiratory distress syndrome, Traumatic pelvis fracture, Intensive care units
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-297911 (URN)10.1186/s13049-016-0244-1 (DOI)000374472700001 ()27095122 (PubMedID)
Funder
Swedish Heart Lung FoundationSwedish Research Council
Available from: 2016-06-29 Created: 2016-06-28 Last updated: 2017-11-28Bibliographically approved
Reinius, H. (2016). Open lung concept in high risk anaesthesia: Optimizing mechanical ventilation in morbidly obese patients and during one lung ventilation with capnothorax. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Open lung concept in high risk anaesthesia: Optimizing mechanical ventilation in morbidly obese patients and during one lung ventilation with capnothorax
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Formation of atelectasis, defined as reversible collapse of aerated lung, often occurs after induction of anaesthesia with mechanical ventilation. As a consequence, there is a risk for hypoxemia, altered hemodynamics and impaired respiratory system mechanics. In certain situations, the risk for atelectasis formation is increased and its consequences may also be more difficult to manage. Anesthesia for bariatric surgery in morbidly obese patients and surgery requiring one-lung ventilation (OLV) with capnothorax are examples of such situations.

In Paper I (30 patients with BMI > 40 kg/m2 scheduled for bariatric surgery) a recruit­ment maneuver followed by positive end-expiratory pressure (PEEP) re­duced the amount of atelectasis and improved oxygenation for a prolonged period of time. PEEP or a recruitment maneuver alone did not reduce the amount of atelectasis.

In paper II we investigated whether it is possible to predict respiratory function impairment in morbidly obese patients without pulmonary disease from a preoperative lung function test. Patients with mild signs of airway obstruction (reduced end-expiratory flow) in the preoperative spirometry developed less atelectasis during anaesthesia.

In paper III we developed an experimental model of sequential OLV with capnothorax using electrical impedance tomography (EIT) that in real-time detected lung separation and dynamic changes in pulmonary ventilation and perfusion distributions. OLV to the left side caused a decrease in cardiac output, arterial oxygenation and mixed venous saturation.

In paper IV we used our model of OLV with capnothorax and applied a CO2-insufflation pressure of 16 cm H2O. We demonstrated that a PEEP level of 12-16 cm H2O is needed for optimal oxygenation and lowest possible driving pressure without compromising hemodynamic variables. Thus, the optimal PEEP was closely related to the level of the capnothorax insufflation pressure. With insufficient PEEP, ventilation/perfusion mismatch in the ventilated lung and redistribution of blood flow to the non-ventilated lung occurred.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. p. 77
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1169
Keywords
Anaesthesia, mechanical ventilation, atelectasis, morbidly obese, one-lung ventilation, PEEP, recruitment maneuver, spirometry, EIT
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-268498 (URN)978-91-554-9440-7 (ISBN)
Public defence
2016-02-12, Grönwallssalen, Ing. 70, Akademiska sjukhuset, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-01-22 Created: 2015-12-06 Last updated: 2018-05-18
Dyrdak, R., Grabbe, M., Hammas, B., Ekwall, J., Hansson, K. E., Luthander, J., . . . Albert, J. (2016). Outbreak of enterovirus D68 of the new B3 lineage in Stockholm, Sweden, August to September 2016. Eurosurveillance, 21(46), 5-10
Open this publication in new window or tab >>Outbreak of enterovirus D68 of the new B3 lineage in Stockholm, Sweden, August to September 2016
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2016 (English)In: Eurosurveillance, ISSN 1025-496X, E-ISSN 1560-7917, Vol. 21, no 46, p. 5-10Article in journal (Refereed) Published
Abstract [en]

We report an enterovirus D68 ( EV-D68) outbreak in Stockholm Sweden in 2016. Between 22 August and 25 September EV-D68 was detected in 74/ 495 respiratory samples analysed at the Karolinska University Hospital. During the peak week, 30/ 91 ( 33%) samples were EV-D68 positive. Viral protein ( VP) P4/ VP2 sequencing revealed that cases were caused by B3 lineage strains. Forty-four ( 59%) EV-D68-positive patients were children aged = 5 years. Ten patients had severe respiratory or neurological symptoms and one died. We report an outbreak of enterovirus D68 ( EV-D68) infections in Stockholm, Sweden in late August and September of 2016 caused by the newly described B3 lineage [1].

National Category
Infectious Medicine
Identifiers
urn:nbn:se:uu:diva-312083 (URN)10.2807/1560-7917.ES.2016.21.46.30403 (DOI)000388813900002 ()
Available from: 2017-02-01 Created: 2017-01-04 Last updated: 2017-11-29Bibliographically approved
Reinius, H., Borges, J. B., Fredén, F., Jideus, L., Camargo, E. D., Amato, M. B., . . . Lennmyr, F. (2015). Real-time ventilation and perfusion distributions by electrical impedance tomography during one-lung ventilation with capnothorax. Acta Anaesthesiologica Scandinavica, 59(3), 354-368
Open this publication in new window or tab >>Real-time ventilation and perfusion distributions by electrical impedance tomography during one-lung ventilation with capnothorax
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2015 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 3, p. 354-368Article in journal (Refereed) Published
Abstract [en]

Background: Carbon dioxide insufflation into the pleural cavity, capnothorax, with one-lung ventilation (OLV) may entail respiratory and hemodynamic impairments. We investigated the online physiological effects of OLV/capnothorax by electrical impedance tomography (EIT) in a porcine model mimicking the clinical setting.

Methods: Five anesthetized, muscle-relaxed piglets were subjected to first right and then left capnothorax with an intra-pleural pressure of 19cm H2O. The contra-lateral lung was mechanically ventilated with a double-lumen tube at positive end-expiratory pressure 5 and subsequently 10cm H2O. Regional lung perfusion and ventilation were assessed by EIT. Hemodynamics, cerebral tissue oxygenation and lung gas exchange were also measured.

Results: During right-sided capnothorax, mixed venous oxygen saturation (P=0.018), as well as a tissue oxygenation index (P=0.038) decreased. There was also an increase in central venous pressure (P=0.006), and a decrease in mean arterial pressure (P=0.045) and cardiac output (P=0.017). During the left-sided capnothorax, the hemodynamic impairment was less than during the right side. EIT revealed that during the first period of OLV/capnothorax, no or very minor ventilation on the right side could be seen (33% vs. 97 +/- 3%, right vs. left, P=0.007), perfusion decreased in the non-ventilated and increased in the ventilated lung (18 +/- 2% vs. 82 +/- 2%, right vs. left, P=0.03). During the second OLV/capnothorax period, a similar distribution of perfusion was seen in the animals with successful separation (84 +/- 4% vs. 16 +/- 4%, right vs. left).

Conclusion: EIT detected in real-time dynamic changes in pulmonary ventilation and perfusion distributions. OLV to the left lung with right-sided capnothorax caused a decrease in cardiac output, arterial oxygenation and mixed venous saturation.

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-248178 (URN)10.1111/aas.12455 (DOI)000349604000010 ()25556329 (PubMedID)
Note

De 2 första författarna delar förstaförfattarskapet.

Available from: 2015-04-12 Created: 2015-03-30 Last updated: 2017-12-04Bibliographically approved
Engström, J., Reinius, H., Fröjd, C., Jonsson, H., Hedenstierna, G. & Larsson, A. (2014). Maintenance of Airway Pressure During Filter Exchange Due to Auto-Triggering. Respiratory care, 59(8), 1210-1217
Open this publication in new window or tab >>Maintenance of Airway Pressure During Filter Exchange Due to Auto-Triggering
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2014 (English)In: Respiratory care, ISSN 0020-1324, E-ISSN 1943-3654, Vol. 59, no 8, p. 1210-1217Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Daily routine ventilator-filter exchange interrupts the integrity of the ventilator circuit. We hypothesized that this might reduce positive airway pressure in mechanically ventilated ICU patients, inducing alveolar collapse and causing impaired oxygenation and compliance of the respiratory system. METHODS: We studied 40 consecutive ICU subjects (P-aO2/F-IO2 ratio <= 300 mm Hg), mechanically ventilated with pressure-regulated volume control or pressure support and PEEP >= 5 cm H2O. Before the filter exchange, (baseline) tidal volume, breathing frequency,end-inspiratory plateau pressure, and PEEP were recorded. Compliance of the respiratory system was calculated; F-IO2, blood pressure, and pulse rate were registered; and P-aO2, P-aCO2, pH, and base excess were measured. Measurements were repeated 15 and 60 min after the filter exchange. In addition, a bench test was performed with a precision test lung with similar compliance and resistance as in the clinical study. RESULTS: The exchange of the filter took 3.5 +/- 1.2 s (mean +/- SD). There was no significant change in P-aO2 (89 +/- 16 mm Hg at baseline vs 86 +/- 16 mm Hg at 15 min and 88 +/- 18 mm Hg at 60 min, P = .24) or in compliance of the respiratory system (41 +/- 11 mL/cm H2O at baseline vs 40 +/- 12 mL/cm H2O at 15 min and 40 +/- 12 mL/cm H2O at 60 min, P = .32). The bench study showed that auto-triggering by the ventilator when disconnecting from the expiratory circuit kept the tracheal pressure above PEEP for at least 3 s with pressure controlled ventilation. CONCLUSIONS: This study showed that a short disconnection of the expiratory ventilator circuit from the ventilator during filter exchange was not associated with any significant deterioration in lung function 15 and 60 min later. This result may be explained by auto-triggering of the ventilator with high inspiratory flows during the filter exchange, maintaining airway pressure. (ISRCTN.org registration ISRCTN76631800.)

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-216400 (URN)10.4187/respcare.02892 (DOI)000349199900007 ()24282318 (PubMedID)
Available from: 2014-01-21 Created: 2014-01-21 Last updated: 2017-12-06Bibliographically approved
Espes, D., Engström, J., Reinius, H. & Carlsson, P.-O. (2013). Severe diabetic ketoacidosis in combination with starvation and anorexia nervosa at onset of type 1 diabetes: A case report. Upsala Journal of Medical Sciences, 118(2), 130-133
Open this publication in new window or tab >>Severe diabetic ketoacidosis in combination with starvation and anorexia nervosa at onset of type 1 diabetes: A case report
2013 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 118, no 2, p. 130-133Article in journal (Refereed) Published
Abstract [en]

We here report a case of diabetic ketoacidosis at onset of type 1 diabetes after a prolonged period of starvation due to anorexia nervosa. A 53-year-old female with a history of anorexia nervosa was admitted to the psychiatric clinic due to psychotic behaviour and inability to take care of herself. Twenty-four hours after admission she was transferred to the clinic of internal medicine due to altered mental status, and laboratory screening revealed a pH of 6.895 and blood glucose concentration of 40 mmol/L. Due to the unusual combination of prolonged starvation and diabetic ketoacidosis we implemented some modifications of existing treatment guidelines and some special considerations regarding nutrition in order to prevent a re-feeding syndrome.

Keywords
Anorexia nervosa, diabetic ketoacidosis, starvation, type 1 diabetes
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-200057 (URN)10.3109/03009734.2013.786000 (DOI)000317486000010 ()
Available from: 2013-05-23 Created: 2013-05-20 Last updated: 2017-12-06Bibliographically approved
Reinius, H., Jonsson, L., Gustafsson, S., Sundbom, M., Duvernoy, O., Pelosi, P., . . . Fredén, F. (2009). Prevention of atelectasis in morbidly obese patients during general anesthesia and paralysis: a computerized tomography study. Anesthesiology, 111(5), 979-987
Open this publication in new window or tab >>Prevention of atelectasis in morbidly obese patients during general anesthesia and paralysis: a computerized tomography study
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2009 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 111, no 5, p. 979-987Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Morbidly obese patients show impaired pulmonary function during anesthesia and paralysis, partly due to formation of atelectasis. This study analyzed the effect of general anesthesia and three different ventilatory strategies to reduce the amount of atelectasis and improve respiratory function. METHODS: Thirty patients (body mass index 45 +/- 4 kg/m) scheduled for gastric bypass surgery were prospectively randomized into three groups: (1) positive end-expiratory pressure of 10 cm H2O (PEEP), (2) a recruitment maneuver with 55 cm H2O for 10 s followed by zero end-expiratory pressure, (3) a recruitment maneuver followed by PEEP. Transverse lung computerized tomography scans and blood gas analysis were recorded: awake, 5 min after induction of anesthesia and paralysis at zero end-expiratory pressure, and 5 min and 20 min after intervention. In addition, spiral computerized tomography scans were performed at two occasions in 23 of the patients. RESULTS: After induction of anesthesia, atelectasis increased from 1 +/- 0.5% to 11 +/- 6% of total lung volume (P < 0.0001). End-expiratory lung volume decreased from 1,387 +/- 581 ml to 697 +/- 157 ml (P = 0.0014). A recruitment maneuver + PEEP reduced atelectasis to 3 +/- 4% (P = 0.0002), increased end-expiratory lung volume and increased Pao2/Fio2 from 266 +/- 70 mmHg to 412 +/- 99 mmHg (P < 0.0001). PEEP alone did not reduce the amount of atelectasis or improve oxygenation. A recruitment maneuver + zero end-expiratory pressure had a transient positive effect on respiratory function. All values are presented as mean +/- SD. CONCLUSIONS: A recruitment maneuver followed by PEEP reduced atelectasis and improved oxygenation in morbidly obese patients, whereas PEEP or a recruitment maneuver alone did not.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-113069 (URN)10.1097/ALN.0b013e3181b87edb (DOI)000271172500009 ()19809292 (PubMedID)
Available from: 2010-01-25 Created: 2010-01-25 Last updated: 2017-12-12Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3495-2929

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