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A ventilation strategy during general anaesthesia to reduce postoperative atelectasis
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
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2014 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 119, no 3, 242-250 p.Article in journal (Refereed) Published
Abstract [en]

Background:

Atelectasis is common during and after general anaesthesia. We hypothesized that a ventilation strategy, without recruitment manoeuvres, using a combination of continuous positive airway pressure (CPAP) or positive end-expiratory pressure (PEEP) and a reduced end-expiratory oxygen fraction (FETO2) before ending mask ventilation with CPAP after extubation would reduce the area of postoperative atelectasis.

Methods:

Thirty patients were randomized into three groups. During induction and emergence, inspiratory oxygen fractions (FIO2) were 1.0 in the control group and 1.0 or 0.8 in the intervention groups. No CPAP/PEEP was used in the control group, whereas CPAP/PEEP of 6 cmH2O was used in the intervention groups. After extubation, FIO2 was set to 0.30 in the intervention groups and CPAP was applied, aiming at FETO2 < 0.30. Atelectasis was studied by computed tomography 25 min postoperatively.

Results:

The median area of atelectasis was 5.2 cm(2) (range 1.6-12.2 cm(2)) and 8.5 cm(2) (3-23.1 cm(2)) in the groups given FIO2 1.0 with or without CPAP/PEEP, respectively. After correction for body mass index the difference between medians (2.9 cm(2)) was statistically significant (confidence interval 0.2-7.6 cm(2), p = 0.04). In the group given FIO2 0.8, in which seven patients were ex- or current smokers, the median area of atelectasis was 8.2 cm(2) (1.8-14.7 cm(2)).

Conclusion:

Compared with conventional ventilation, after correction for obesity, this ventilation strategy reduced the area of postoperative atelectasis in one of the intervention groups but not in the other group, which included a higher proportion of smokers.

Place, publisher, year, edition, pages
2014. Vol. 119, no 3, 242-250 p.
National Category
Medical and Health Sciences
Research subject
Clinical Physiology
Identifiers
URN: urn:nbn:se:uu:diva-224691DOI: 10.3109/03009734.2014.909546ISI: 000340110800005PubMedID: 24758245OAI: oai:DiVA.org:uu-224691DiVA: diva2:718233
Available from: 2014-05-20 Created: 2014-05-18 Last updated: 2017-12-05Bibliographically approved

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Edmark, LennartHedenstierna, GöranEnlund, Mats

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Clinical PhysiologyCentre for Clinical Research, County of Västmanland
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