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Positive End-expiratory Pressure and Postoperative Atelectasis: A Randomized Controlled Trial
Vasteras Hosp, Dept Anesthesia & Intens Care, Vasteras, Sweden;Koping Cty Hosp, Dept Anesthesia & Intens Care, Koping, Sweden.
Vasteras Hosp, Dept Radiol, Vasteras, Sweden.
Vasteras Hosp, Ctr Clin Res, Vasteras, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
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2019 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 131, no 4, p. 809-817Article in journal (Refereed) Published
Abstract [en]

Background:

Positive end-expiratory pressure (PEEP) increases lung volume and protects against alveolar collapse during anesthesia. During emergence, safety preoxygenation preparatory to extubation makes the lung susceptible to gas absorption and alveolar collapse, especially in dependent regions being kept open by PEEP. We hypothesized that withdrawing PEEP before starting emergence preoxygenation would limit postoperative atelectasis formation.

Methods:

This was a randomized controlled evaluator-blinded trial in 30 healthy patients undergoing nonabdominal surgery under general anesthesia and mechanical ventilation with PEEP 7 or 9 cm H2O depending on body mass index. A computed tomography scan at the end of surgery assessed baseline atelectasis. The study subjects were thereafter allocated to either maintained PEEP (n = 16) or zero PEEP (n = 14) during emergence preoxygenation. The primary outcome was change in atelectasis area as evaluated by a second computed tomography scan 30 min after extubation. Oxygenation was assessed by arterial blood gases.

Results:

Baseline atelectasis was small and increased modestly during awakening, with no statistically significant difference between groups. With PEEP applied during awakening, the increase in atelectasis area was median ( range) 1.6 (-1.1 to 12.3) cm(2) and without PEEP 2.3 (-1.6 to 7.8) cm(2). The difference was 0.7 cm(2) (95% CI, -0.8 to 2.9 cm(2); P = 0.400). Postoperative atelectasis for all patients was median 5.2 cm(2) (95% CI, 4.3 to 5.7 cm(2)), corresponding to median 2.5% of the total lung area (95% CI, 2.0 to 3.0%). Postoperative oxygenation was unchanged in both groups when compared to oxygenation in the preoperative awake state.

Conclusions:

Withdrawing PEEP before emergence preoxygenation does not reduce atelectasis formation after nonabdominal surgery. Despite using 100% oxygen during awakening, postoperative atelectasis is small and does not affect oxygenation, possibly conditional on an open lung during anesthesia, as achieved by intraoperative PEEP.

Place, publisher, year, edition, pages
2019. Vol. 131, no 4, p. 809-817
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-396648DOI: 10.1097/ALN.0000000000002764ISI: 000489733000012PubMedID: 31107276OAI: oai:DiVA.org:uu-396648DiVA, id: diva2:1370257
Available from: 2019-11-14 Created: 2019-11-14 Last updated: 2019-11-14Bibliographically approved

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Zetterström, HenrikHedenstierna, Göran

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