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Suarez-Sipmann, FernandoORCID iD iconorcid.org/0000-0002-7412-2970
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Publications (10 of 45) Show all publications
Gogniat, E., Ducrey, M., Dianti, J., Madorno, M., Roux, N., Midley, A., . . . Tusman, G. (2018). Dead space analysis at different levels of positive end-expiratory pressure in acute respiratory distress syndrome patients. Paper presented at National Meeting of Intensive Care Medicine, OCT, 2015, Mar del Plata, ARGENTINA. Journal of critical care, 45, 231-238
Open this publication in new window or tab >>Dead space analysis at different levels of positive end-expiratory pressure in acute respiratory distress syndrome patients
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2018 (English)In: Journal of critical care, ISSN 0883-9441, E-ISSN 1557-8615, Vol. 45, p. 231-238Article in journal (Refereed) Published
Abstract [en]

Purpose: To analyze the effects of positive end-expiratory pressure (PEEP) on Bohr's dead space (VDBohr/VT) in patients with acute respiratory distress syndrome (ARDS).

Material and methods: Fourteen ARDS patients under lung protective ventilation settingswere submitted to 4 different levels of PEEP (0, 6, 10, 16 cmH(2)O). Respiratory mechanics, hemodynamics and volumetric capnography were recorded at each protocol step.

Results: Two groups of patients responded differently to PEEP when comparing baseline with 16-PEEP: those in which driving pressure increased > 15% (Delta P.(15%), n = 7, p = .016) and those in which the change was <= 15% (Delta P-<= 15%, n = 7, p = .700). VDBohr/VT was higher in Delta P-<= 15% than in Delta P-<= 15% patients at baseline ventilation [0.58 (0.49-0.60) vs 0.46 (0.43-0.46) p = .018], at 0-PEEP [0.50 (0.47-0.54) vs 0.41 (0.40-0.43) p = .012], at 6-PEEP [0.55 (0.49-0.57) vs 0.44 (0.42-0.45) p = .008], at 10-PEEP [0.59 (0.51-0.59) vs 0.45 (0.44-0.46) p = .006] and at 16-PEEP [0.61 (0.56-0.65) vs 0.47 (0.45-0.48) p =. 001]. We found a good correlation between Delta P and VDBohr/VT only in the Delta P.(15%) group (r = 0.74, p < .001).

Conclusions: Increases in PEEP result in higher VDBohr/VT only when associated with an increase in driving pressure.

Place, publisher, year, edition, pages
W B SAUNDERS CO-ELSEVIER INC, 2018
Keywords
ARDS, Volumetric capnography, PEEP, PACO(2), Dead space, Carbon dioxide
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-356615 (URN)10.1016/j.jcrc.2018.01.005 (DOI)000432695500037 ()29754942 (PubMedID)
Conference
National Meeting of Intensive Care Medicine, OCT, 2015, Mar del Plata, ARGENTINA
Available from: 2018-08-20 Created: 2018-08-20 Last updated: 2018-08-20Bibliographically approved
Suarez Sipmann, F., Santos, A. & Tusman, G. (2018). Heart-lung interactions in acute respiratory distress syndrome: pathophysiology, detection and management strategies. Annals of Translational Medicine, 6(2), Article ID 27.
Open this publication in new window or tab >>Heart-lung interactions in acute respiratory distress syndrome: pathophysiology, detection and management strategies
2018 (English)In: Annals of Translational Medicine, ISSN 2305-5839, E-ISSN 2305-5847, Vol. 6, no 2, article id 27Article, review/survey (Refereed) Published
Abstract [en]

Acute respiratory distress syndrome (ARDS) is the most severe form of acute respiratory failure characterized by diffuse alveolar and endothelial damage. The severe pathophysiological changes in lung parenchyma and pulmonary circulation together with the effects of positive pressure ventilation profoundly affect heart lung interactions in ARDS. The term pulmonary vascular dysfunction (PVD) refers to the specific involvement of the vascular compartment in ARDS and is expressed clinically by an increase in pulmonary arterial (PA) pressure and pulmonary vascular resistance both affecting right ventricular (RV) afterload. When severe, PVD can lead to RV failure which is associated to an increased mortality. The effect of PVD on RV function is not only a consequence of increased pulmonary vascular resistance as afterload is a much more complex phenomenon that includes all factors that oppose efficient ventricular ejection. Impaired pulmonary vascular mechanics including increased arterial elastance and augmented wave-reflection phenomena are commonly seen in ARDS and can additionally affect RV afterload. The use of selective pulmonary vasodilators and lung protective mechanical ventilation strategies are therapeutic interventions that can ameliorate PVD. Prone positioning and the open lung approach (OLA) are especially attractive strategies to improve PVD due to their effects on increasing functional lung volume. In this review we will describe some pathophysiological aspects of heart-lung interactions during the ventilatory support of ARDS, its clinical assessment and discuss therapeutic interventions to prevent the occurrence and progression of PVD and RV failure.

Place, publisher, year, edition, pages
AME PUBL CO, 2018
Keywords
Acute respiratory distress syndrome (ARDS), pulmonary vascular dysfunction (PVD), pulmonary vascular resistance (PVR), lung protective ventilation, positive end-expiratory pressure (PEEP), pulmonary vascular mechanics, prone positioning, open lung approach (OLA)
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-350116 (URN)10.21037/atm.2017.12.07 (DOI)000423443000007 ()29430444 (PubMedID)
Available from: 2018-05-07 Created: 2018-05-07 Last updated: 2018-05-07Bibliographically approved
Ferrando, C., Soro, M., Unzueta, C., Suarez-Sipmann, F., Canet, J., Librero, J., . . . Belda, J. (2018). Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial. The Lancet Respiratory Medicine, 6(3), 193-203
Open this publication in new window or tab >>Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial
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2018 (English)In: The Lancet Respiratory Medicine, ISSN 2213-2600, E-ISSN 2213-2619, Vol. 6, no 3, p. 193-203Article in journal (Refereed) Published
Abstract [en]

Background The effects of individualised perioperative lung-protective ventilation (based on the open-lung approach [OLA]) on postoperative complications is unknown. We aimed to investigate the effects of intraoperative and postoperative ventilatory management in patients scheduled for abdominal surgery, compared with standard protective ventilation. Methods We did this prospective, multicentre, randomised controlled trial in 21 teaching hospitals in Spain. We enrolled patients who were aged 18 years or older, were scheduled to have abdominal surgery with an expected time of longer than 2 h, had intermediate-to-high-risk of developing postoperative pulmonary complications, and who had a body-mass index less than 35 kg/m(2). Patients were randomly assigned (1: 1: 1: 1) online to receive one of four lung-protective ventilation strategies using low tidal volume plus positive end-expiratory pressure (PEEP): open-lung approach (OLA)-iCPAP (individualised intraoperative ventilation [individualised PEEP after a lung recruitment manoeuvre] plus individualised postoperative continuous positive airway pressure [CPAP]), OLA-CPAP (intraoperative individualised ventilation plus postoperative CPAP), STD-CPAP (standard intraoperative ventilation plus postoperative CPAP), or STD-O-2 (standard intraoperative ventilation plus standard postoperative oxygen therapy). Patients were masked to treatment allocation. Investigators were not masked in the operating and postoperative rooms; after 24 h, data were given to a second investigator who was masked to allocations. The primary outcome was a composite of pulmonary and systemic complications during the first 7 postoperative days. We did the primary analysis using the modified intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT02158923. Findings Between Jan 2, 2015, and May 18, 2016, we enrolled 1012 eligible patients. Data were available for 967 patients, whom we included in the final analysis. Risk of pulmonary and systemic complications did not differ for patients in OLA-iCPAP (110 [46%] of 241, relative risk 0.89 [95% CI 0.74-1.07; p=0.25]), OLA-CPAP (111 [47%] of 238, 0.91 [0.76-1.09; p=0.35]), or STD-CPAP groups (118 [48%] of 244, 0.95 [0.80-1.14; p=0.65]) when compared with patients in the STD-O-2 group (125 [51%] of 244). Intraoperatively, PEEP was increased in 69 (14%) of patients in the standard perioperative ventilation groups because of hypoxaemia, and no patients from either of the OLA groups required rescue manoeuvres. Interpretation In patients who have major abdominal surgery, the different perioperative open lung approaches tested in this study did not reduce the risk of postoperative complications when compared with standard lung-protective mechanical ventilation.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2018
National Category
Anesthesiology and Intensive Care Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-350497 (URN)10.1016/S2213-2600(18)30024-9 (DOI)000426242800020 ()29371130 (PubMedID)
Available from: 2018-05-09 Created: 2018-05-09 Last updated: 2018-05-09Bibliographically approved
Sigmundsson, T. S., Öhman, T., Hallbäck, M., Redondo, E., Suarez-Sipmann, F., Wallin, M., . . . Björne, H. (2018). Performance of a capnodynamic method estimating effective pulmonary blood flow during transient and sustained hypercapnia. Journal of clinical monitoring and computing, 32(2), 311-319
Open this publication in new window or tab >>Performance of a capnodynamic method estimating effective pulmonary blood flow during transient and sustained hypercapnia
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2018 (English)In: Journal of clinical monitoring and computing, ISSN 1387-1307, E-ISSN 1573-2614, Vol. 32, no 2, p. 311-319Article in journal (Refereed) Published
Abstract [en]

The capnodynamic method is a minimally invasive method continuously calculating effective pulmonary blood flow (COEPBF), equivalent to cardiac output when intra pulmonary shunt flow is low. The capnodynamic equation joined with a ventilator pattern containing cyclic reoccurring expiratory holds, provides breath to breath hemodynamic monitoring in the anesthetized patient. Its performance however, might be affected by changes in the mixed venous content of carbon dioxide (CvCO2). The aim of the current study was to evaluate COEPBF during rapid measurable changes in mixed venous carbon dioxide partial pressure (PvCO2) following ischemia-reperfusion and during sustained hypercapnia in a porcine model. Sixteen pigs were submitted to either ischemia-reperfusion (n = 8) after the release of an aortic balloon inflated during 30 min or to prolonged hypercapnia (n = 8) induced by adding an instrumental dead space. Reference cardiac output (CO) was measured by an ultrasonic flow probe placed around the pulmonary artery trunk (COTS). Hemodynamic measurements were obtained at baseline, end of ischemia and during the first 5 min of reperfusion as well as during prolonged hypercapnia at high and low CO states. Ischemia-reperfusion resulted in large changes in PvCO2, hemodynamics and lactate. Bias (limits of agreement) was 0.7 (-0.4 to 1.8) L/min with a mean error of 28% at baseline. COEPBF was impaired during reperfusion but agreement was restored within 5 min. During prolonged hypercapnia, agreement remained good during changes in CO. The mean polar angle was -4.19A degrees (-8.8A degrees to 0.42A degrees). Capnodynamic COEPBF is affected but recovers rapidly after transient large changes in PvCO2 and preserves good agreement and trending ability during states of prolonged hypercapnia at different levels of CO.

Place, publisher, year, edition, pages
SPRINGER HEIDELBERG, 2018
Keywords
Carbon dioxide, Cardiac output, Intraoperative monitoring, Effective pulmonary blood flow, Capnodynamic, Animal model
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-350733 (URN)10.1007/s10877-017-0021-3 (DOI)000426788500016 ()28497180 (PubMedID)
Funder
Stockholm County Council, 20140430, 20150910
Available from: 2018-05-16 Created: 2018-05-16 Last updated: 2018-05-16Bibliographically approved
Tusman, G., Acosta, C., Longo, S. & Suarez-Sipmann, F. (2018). Reply to: alveolar recruitment manoeuvres after cardiac surgery [Letter to the editor]. European Journal of Anaesthesiology, 35(1), 62-63
Open this publication in new window or tab >>Reply to: alveolar recruitment manoeuvres after cardiac surgery
2018 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 1, p. 62-63Article in journal, Letter (Refereed) Published
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-347705 (URN)10.1097/EJA.0000000000000657 (DOI)000418869400011 ()
Available from: 2018-04-06 Created: 2018-04-06 Last updated: 2018-04-06Bibliographically approved
Hällsjö Sander, C., Sigmundsson, T., Hallbäck, M., Suarez-Sipmann, F., Wallin, M., Oldner, A. & Björne, H. (2017). A modified breathing pattern improves the performance of a continuous capnodynamic method for estimation of effective pulmonary blood flow. Journal of clinical monitoring and computing, 31(4), 717-725
Open this publication in new window or tab >>A modified breathing pattern improves the performance of a continuous capnodynamic method for estimation of effective pulmonary blood flow
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2017 (English)In: Journal of clinical monitoring and computing, ISSN 1387-1307, E-ISSN 1573-2614, Vol. 31, no 4, p. 717-725Article in journal (Refereed) Published
Abstract [en]

In a previous study a new capnodynamic method for estimation of effective pulmonary blood flow (COEPBF) presented a good trending ability but a poor agreement with a reference cardiac output (CO) measurement at high levels of PEEP. In this study we aimed at evaluating the agreement and trending ability of a modified COEPBF algorithm that uses expiratory instead of inspiratory holds during CO and ventilatory manipulations. COEPBF was evaluated in a porcine model at different PEEP levels, tidal volumes and CO manipulations (N = 8). An ultrasonic flow probe placed around the pulmonary trunk was used for CO measurement. We tested the COEPBF algorithm using a modified breathing pattern that introduces cyclic end-expiratory time pauses. The subsequent changes in mean alveolar fraction of carbon dioxide were integrated into a capnodynamic equation and effective pulmonary blood flow, i.e. non-shunted CO, was calculated continuously breath by breath. The overall agreement between COEPBF and the reference method during all interventions was good with bias (limits of agreement) 0.05 (-1.1 to 1.2) L/min and percentage error of 36 %. The overall trending ability as assessed by the four-quadrant and the polar plot methodology was high with a concordance rate of 93 and 94 % respectively. The mean polar angle was 0.4 (95 % CI -3.7 to 4.5)A degrees. A ventilatory pattern recurrently introducing end-expiratory pauses maintains a good agreement between COEPBF and the reference CO method while preserving its trending ability during CO and ventilatory alterations.

Place, publisher, year, edition, pages
SPRINGER HEIDELBERG, 2017
Keywords
Monitoring, Carbon dioxide, Cardiac output, Perioperative
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-329906 (URN)10.1007/s10877-016-9891-z (DOI)000405018900009 ()27251701 (PubMedID)
Funder
The Karolinska Institutet's Research FoundationStockholm County Council
Available from: 2018-02-22 Created: 2018-02-22 Last updated: 2018-02-22Bibliographically approved
Villar, J., Martin-Rodriguez, C., Dominguez-Berrot, A. M., Fernandez, L., Ferrando, C., Soler, J. A., . . . Kacmarek, R. M. (2017). A Quantile Analysis of Plateau and Driving Pressures: Effects on Mortality in Patients With Acute Respiratory Distress Syndrome Receiving Lung-Protective Ventilation. Critical Care Medicine, 45(5), 843-850
Open this publication in new window or tab >>A Quantile Analysis of Plateau and Driving Pressures: Effects on Mortality in Patients With Acute Respiratory Distress Syndrome Receiving Lung-Protective Ventilation
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2017 (English)In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 45, no 5, p. 843-850Article in journal (Refereed) Published
Abstract [en]

Objectives: The driving pressure (plateau pressure minus positive end-expiratory pressure) has been suggested as the major determinant for the beneficial effects of lung-protective ventilation. We tested whether driving pressure was superior to the variables that define it in predicting outcome in patients with acute respiratory distress syndrome.

Design: A secondary analysis of existing data from previously reported observational studies.

Setting: A network of ICUs.

Patients: We studied 778 patients with moderate to severe acute respiratory distress syndrome.

Interventions: None.

Measurements and Main Results: We assessed the risk of hospital death based on quantiles of tidal volume, positive end-expiratory pressure, plateau pressure, and driving pressure evaluated at 24 hours after acute respiratory distress syndrome diagnosis while ventilated with standardized lung-protective ventilation. We derived our model using individual data from 478 acute respiratory distress syndrome patients and assessed its replicability in a separate cohort of 300 acute respiratory distress syndrome patients. Tidal volume and positive end-expiratory pressure had no impact on mortality. We identified a plateau pressure cut-off value of 29 cm H2O, above which an ordinal increment was accompanied by an increment of risk of death. We identified a driving pressure cut-off value of 19 cm H2O where an ordinal increment was accompanied by an increment of risk of death. When we cross tabulated patients with plateau pressure less than 30 and plateau pressure greater than or equal to 30 with those with driving pressure less than 19 and driving pressure greater than or equal to 19, plateau pressure provided a slightly better prediction of outcome than driving pressure in both the derivation and validation cohorts (p < 0.0000001).

Conclusions: Plateau pressure was slightly better than driving pressure in predicting hospital death in patients managed with lung-protective ventilation evaluated on standardized ventilator settings 24 hours after acute respiratory distress syndrome onset.

Keywords
acute respiratory distress syndrome, driving pressure, plateau pressure, protective mechanical ventilation, outcome
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-322087 (URN)10.1097/CCM.0000000000002330 (DOI)000399522200013 ()28252536 (PubMedID)
Available from: 2017-05-16 Created: 2017-05-16 Last updated: 2017-05-16Bibliographically approved
Tusman, G., Bohm, S. H. & Suarez-Sipmann, F. (2017). Advanced Uses of Pulse Oximetry for Monitoring Mechanically Ventilated Patients. Anesthesia and Analgesia, 124(1), 62-71
Open this publication in new window or tab >>Advanced Uses of Pulse Oximetry for Monitoring Mechanically Ventilated Patients
2017 (English)In: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 124, no 1, p. 62-71Article in journal (Refereed) Published
Abstract [en]

Pulse oximetry is an undisputable standard of care in clinical monitoring. It combines a spectrometer to detect hypoxemia with a plethysmograph for the diagnosis, monitoring, and follow-up of cardiovascular diseases. These pulse oximetry capabilities are extremely useful for assessing the respiratory and circulatory status and for monitoring of mechanically ventilated patients. On the one hand, the key spectrography-derived function of pulse oximetry is to evaluate a patient's gas exchange that results from a particular ventilatory treatment by continuously and noninvasively measuring arterial hemoglobin saturation (Spo(2)). This information helps to maintain patients above the hypoxemic levels, leading to appropriate ventilator settings and inspired oxygen fractions. However, whenever higher than normal oxygen fractions are used, Spo(2) can mask existing oxygenation defects in ventilated patients. This limitation, resulting from the S shape of the oxyhemoglobin saturation curve, can be overcome by reducing the oxygen fraction delivered to the patient in a controlled and stepwise manner. This results in a Spo(2)/Fio(2) diagram, which allows a rough characterization of a patient's gas exchange, shunt, and the amount of lung area with a low ventilation/perfusion ratio without the need of blood sampling. On the other hand, the photoplethysmography-derived oximeter function has barely been exploited for the purpose of monitoring hemodynamics in mechanically ventilated patients. The analysis of the photoplethysmography contour provides useful real-time and noninvasive information about the interaction of heart and lungs during positive pressure ventilation. These hemodynamic monitoring capabilities are related to both the assessment of preload dependency mainly by analyzing the breath-by-breath variation of the photoplethysmographic signals and the analysis of arterial impedance, Which examines the changes in the plethysmographic amplitude, contour, and derived indexes. In this article, we present and describe these extended monitoring capabilities and propose a more holistic monitoring concept that takes advantage of these advanced uses of pulse oximetry in the monitoring of ventilated patients. Today's monitors need to be improved if such novel functionalities were to be offered for clinical use. Future developments and clinical evaluations are needed to establish the true potential of these advanced monitoring uses of pulse oximetry.

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-359812 (URN)10.1213/ANE.0000000000001283 (DOI)000390613500011 ()27183375 (PubMedID)
Available from: 2018-09-24 Created: 2018-09-24 Last updated: 2018-09-24Bibliographically approved
Santos, A., Gomez-Peñalver, E., Monge-Garcia, M. I., Retamal, J., Batista Borges, J., Tusman, G., . . . Suarez-Sipmann, F. (2017). Effects on Pulmonary Vascular Mechanics of Two Different Lung-Protective Ventilation Strategies in an Experimental Model of Acute Respiratory Distress Syndrome. Critical Care Medicine, 45(11), e1157-e1164
Open this publication in new window or tab >>Effects on Pulmonary Vascular Mechanics of Two Different Lung-Protective Ventilation Strategies in an Experimental Model of Acute Respiratory Distress Syndrome
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2017 (English)In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 45, no 11, p. e1157-e1164Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To compare the effects of two lung-protective ventilation strategies on pulmonary vascular mechanics in early acute respiratory distress syndrome.

DESIGN: Experimental study.

SETTING: University animal research laboratory.

SUBJECTS: Twelve pigs (30.8 ± 2.5 kg).

INTERVENTIONS: Acute respiratory distress syndrome was induced by repeated lung lavages and injurious mechanical ventilation. Thereafter, animals were randomized to 4 hours ventilation according to the Acute Respiratory Distress Syndrome Network protocol or to an open lung approach strategy. Pressure and flow sensors placed at the pulmonary artery trunk allowed continuous assessment of pulmonary artery resistance, effective elastance, compliance, and reflected pressure waves. Respiratory mechanics and gas exchange data were collected.

MEASUREMENTS AND MAIN RESULTS: Acute respiratory distress syndrome led to pulmonary vascular mechanics deterioration. Four hours after randomization, pulmonary vascular mechanics was similar in Acute Respiratory Distress Syndrome Network and open lung approach: resistance (578 ± 252 vs 626 ± 153 dyn.s/cm; p = 0.714), effective elastance, (0.63 ± 0.22 vs 0.58 ± 0.17 mm Hg/mL; p = 0.710), compliance (1.19 ± 0.8 vs 1.50 ± 0.27 mL/mm Hg; p = 0.437), and reflection index (0.36 ± 0.04 vs 0.34 ± 0.09; p = 0.680). Open lung approach as compared to Acute Respiratory Distress Syndrome Network was associated with improved dynamic respiratory compliance (17.3 ± 2.6 vs 10.5 ± 1.3 mL/cm H2O; p < 0.001), driving pressure (9.6 ± 1.3 vs 19.3 ± 2.7 cm H2O; p < 0.001), and venous admixture (0.05 ± 0.01 vs 0.22 ± 0.03, p < 0.001) and lower mean pulmonary artery pressure (26 ± 3 vs 34 ± 7 mm Hg; p = 0.045) despite of using a higher positive end-expiratory pressure (17.4 ± 0.7 vs 9.5 ± 2.4 cm H2O; p < 0.001). Cardiac index, however, was lower in open lung approach (1.42 ± 0.16 vs 2.27 ± 0.48 L/min; p = 0.005).

CONCLUSIONS: In this experimental model, Acute Respiratory Distress Syndrome Network and open lung approach affected pulmonary vascular mechanics similarly. The use of higher positive end-expiratory pressures in the open lung approach strategy did not worsen pulmonary vascular mechanics, improved lung mechanics, and gas exchange but at the expense of a lower cardiac index.

National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-334177 (URN)10.1097/CCM.0000000000002701 (DOI)000417107000007 ()28872540 (PubMedID)
Funder
Swedish Research Council, K2015-99X-22731-01-4Swedish Heart Lung FoundationEU, FP7, Seventh Framework Programme, 291820
Available from: 2017-11-21 Created: 2017-11-21 Last updated: 2018-03-09Bibliographically approved
Longo, S., Siri, J., Acosta, C., Palencia, A., Echegaray, A., Chiotti, I., . . . Tusman, G. (2017). Lung recruitment improves right ventricular performance after cardiopulmonary bypass A randomised controlled trial. European Journal of Anaesthesiology, 34(2), 66-74
Open this publication in new window or tab >>Lung recruitment improves right ventricular performance after cardiopulmonary bypass A randomised controlled trial
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2017 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 34, no 2, p. 66-74Article in journal (Refereed) Published
Abstract [en]

BACKGROUND Atelectasis after cardiopulmonary bypass (CPB) can affect right ventricular (RV) performance by increasing its outflow impedance. OBJECTIVE The aim of this study was to determine whether a lung recruitment manoeuvre improves RV function by re-aerating the lung after CPB. DESIGN Randomised controlled study. SETTING Single-institution study, community hospital, Cordoba, Argentina. PATIENTS Forty anaesthetised patients with New York Heart Association class I or II, preoperative left ventricular ejection fraction at least 50% and Euroscore 6 or less scheduled for cardiac surgery with CPB. INTERVENTIONS Patients were assigned to receive either standard ventilation with 6 cmH(2)O of positive end-expiratory pressure (PEEP; group C, n = 20) or standard ventilation with a recruitment manoeuvre and 10 cmH(2)O of PEEP after surgery (group RM, n = 20). RV function, left ventricular cardiac index (CI) and lung aeration were assessed by transoesophageal echocardiography (TOE) before, at the end of surgery and 30 min after surgery. MAIN OUTCOME MEASURES RV function parameters and atelectasis assessed by TOE. RESULTS Haemodynamic data and atelectasis were similar between groups before surgery. At the end of surgery, CI had decreased from 2.9 +/- 1.1 to 2.6 +/- 0.9 l min(-1) m(-2) in group C (P = 0.24) and from 2.8 +/- 1.0 to 2.6 +/- 0.8 l min(-1) m +/- 2 in group RM (P = 0.32). TOE-derived RV function parameters confirmed a mild decrease in RV performance in 95% of patients, without significant differences between groups (multivariate Hotelling t-test P = 0.16). Atelectasis was present in 18 patients in group C and 19 patients in group RM (P = 0.88). After surgery, CI decreased further from 2.6 to 2.4 l min(-)1 m(-2) in group C (P = 0.17) but increased from 2.6 to 3.7 l min(-1) m(-2) in group RM (P<0.001). TOE-derived RV function parameters improved only in group RM (Hotelling t-test P<0.001). Atelectasis was present in 100% of patients in group C but only in 10% of those in group RM (P<0.001). CONCLUSION Atelectasis after CPB impairs RV function but this can be resolved by lung recruitment using 10 cm H2O of PEEP.

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-316013 (URN)10.1097/EJA.0000000000000559 (DOI)000392170300004 ()27861261 (PubMedID)
Available from: 2017-02-24 Created: 2017-02-24 Last updated: 2017-11-29Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-7412-2970

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