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Different positive end expiratory pressure and tidal volume controls on lung protection and inflammatory factors during surgical anesthesia

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World Journal of Clinical Cases 2022年第33期10卷 12146-12155页

作者： Yu Wang Yi Yang Ding-Mu Wang Jie Li Quan-Tang Bao Bei-Bei Wang Shu-Jun Zhu Lu Zou Department of Anesthesia Xinghua City People's HospitalXinghua 225700Jiangsu ProvinceChina Department of Anesthesiology Suzhou High-Tech Zone People's HospitalSuzhou 215011Jiangsu ProvinceChina Naval Medical Center Naval Medical UniversityPLAShanghai 200433China Department of Anesthesiology Changzhou Hospital of Traditional Chinese MedicineChangzhou 213000Jiangsu ProvinceChina

BACKGROUND Mechanical ventilation can lead to the severe impairment of the metabolic pathway of alveolar surfactants,inactivating alveolar surfactants and significantly reducing lung-chest *** cardiopulmonary function of elderly patients usually reduced to a certain extent,and there are lung complications after surgical anesthesia,just like lung barotrauma caused by mechanical ventilation,atelectasis and postoperative *** To investigate the effects of different positive end expiratory pressures(PEEPs)and tidal volumes(VTs)on respiratory function,the degree of the inflammatory response and hemodynamic indexes in patients undergoing surgery under general *** A total of 120 patients undergoing surgery for gastric or colon cancer under general anesthesia in Xinghua People's Hospital from January 2017 to January 2021 were randomly divided into Group A and Group B,with 60 cases in each *** ventilation mode in Group A was VT(6.0 mL/kg)+PEEP(5.0 cmH_(2)O),while that in Group B was VT(6.0 mL/kg)+PEEP(8.0 cmH_(2)O).Blood gas parameters,respiratory mechanical parameters,inflammatory response indicators,hemodynamic indicators and related complications were compared between the two *** There were no significant differences in PaCO_(2),PaO_(2),oxygen or the examined indexes at T0 between group A and group B(P>0.05).The measured PaO_(2) value of patients in group A at T3 was higher than that in group B,and the difference was significant(P0.05).The measured P_(peak) value of patients in group A at T1 was higher than that in group B,and the difference was significant(P<0.05).The measured Cdyn value at T1 and T2 was greater than that in group B(P<0.05).Before surgery,there were no significant differences in tumor necrosis factor-α(TNF-α),interleukin(IL)-6 or IL-

关键词： General anesthesia Positive end expiratory pressure tidal volume Respiratory function Inflammatory reactions Hemodynamics

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Accuracy and Consistency of Respiratory Inductive Plethysmography for Overnight tidal volume Measurement

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2001年第1期21卷 35-37,58页

作者：张劲农 Eric W Ruch Konrad E Bloch Respiratory Disease Research Laboratory Xiehe Hospital Tongji Medical College Huazhong University of Science and Technology Abteilung Pneumologie Unisipital Zuerich

To validate the accuracy and consistency of respiratory inductive plethysmography (RIP) in measuring tidal volume after an overnight sleep, tidal volumes of 18 patients with suspected sleep disordered breathing and 8 normal volunteers were measured simultaneously with RIP (V TRIP ) and with an ultrasonic airflow meter (V TUFM ) before and after an unstrained overnight sleep on supine and lateral decubitus. The bias of the V TRIP was expressed as (V TRIP V TUFM )/ V TUFM ·100 %, limits of agreement between V TRIP and V TUFM was measured by averaged bias ±2 s . Results showed that in normal subjects, the bias of RIP before and after overnight sleep was precise and consistent in both supine (0.7 % and -1.6 %) and lateral decubitus (3.7 % and -0.56 %). In these patients, the bias of RIP before and after sleep in supine also remained small (1.9 % and 1.7 %), but it became larger in lateral decubitus (24.5 % and 20.4 %) and 11.5 % exceeded the limits of agreement observed in the evening. The patients′ body mass indices (BMI) were higher than those of normal subjects (median 34.2 vs. 27.8 kg/m 2). Pooled data showed that the bias of V TRIP in the morning on lateral decubitus but not on supine was correlated to BMI (Spearman R=0.32, n =52, P =0.02). Thus, we were led to conclude that the accuracy of V TRIP overnight was precise and consistent in normal subjects, but the deviation of V TRIP measured on lateral decubitus in patients especially in those with excessive obesity was greater, thus, the method should not be used for quantitative determination.

关键词： sleep study respiratory inductive plethysmography (RIP) tidal volume

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Alveolar stability under different combinations of positive end-expiratory pressure and tidal volume： alveolar microscopy in isolated injured rat lungs

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Chinese Medical Journal 2010年第4期123卷 406-411页

作者： LIU Hui Claudius A. Stahl Knut Moeller Matthias Schneider Steven Ganzert ZHAO Zhan-qi TONG Xiao-wen Josef Guttmann Department of Breast Surgery Tongji Hospital Tongji University School of Medicine Shanghai 200065 China Department of Anesthesiology and Critical Care Medicine University Medical Center Freiburg 79106 Germany Biomedical Engineering Furtwangen University VS-Schwenningen 78056 Germany Woman Health Care Center of Tongji University Shanghai 200065 China

Background High positive end-expiratory pressure （PEEP） and low tidal volume （VT） ventilation is thought to be a protective ventilation strategy. It is hypothesized that the stabilization of collapsible alveoli during expiration contributes to lung protection. However, this hypothesis came from analysis of indirect indices like the analysis of the pressure-volume curve of the lung. The purpose of this study was to investigate isolated healthy and injured rat lungs by means of alveolar microscopy, in which combination of PEEP and VT is beneficial with respect to alveolar stability （I-E%）. Methods Alveolar stability was investigated in isolated, non-perfused mechanically ventilated rat lungs. Injured lungs were compared with normal lungs. For both groups three PEEP settings （5, 10, 20 cmH20） were combined with three VT settings （6, 10, 15 ml/kg） resulting in nine PEEP-VT combinations per group. Analysis was performed by alveolar microscopy. Results In normal lungs alveolar stability persisted in all PEEP-VT combinations （I-E% （3.2±11.0）%）. There was no significant difference using different settings （P 〉0.01）. In contrast, alveoli in injured lungs were extremely instable at PEEP levels of 5 cmH20 （mean I-E% 100%） and 10 cmH2O （mean I-E% （30.7±16.8）%）; only at a PEEP of 20 cmH20 were alveoli stabilized （mean I-E% of （0.2±9.3）%）. Conclusions In isolated healthy lungs alveolar stability is almost unaffected by different settings of PEEP and VT. In isolated injured lungs only a high PEEP level of 20 cmH2O resulted in stabilized alveoli whereas lower PEEP levels are associated with alveolar instability.

关键词： alveolar microscopy alveolar mechanics tidal volume positive end-expiratory pressure

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Serum and lung endothelin-1 increased in a canine model of ventilator-induced lung injury

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Chinese Medical Journal 2010年第8期123卷 1021-1027页

作者： LAI Tian-shun CAI Shao-xi GUO Zhen-hui Department of Respiratory Medicine Nanfang Hospital Affiliated to Nanfang Medical University Guangzhou Guangdong 510515 China Department of Medical Intensive Care Unit Guangzhou General Hospital of Guangzhou Military Command Guangzhou Guangdong 510010 China

Background Nitric oxide （NO） plays an important role in acute lung injury （ALl）, acute respiratory distress syndrome （ARDS）, and in ventilator-induced lung injury （VILI）. A change in the balance of endothelin-1 （ET-1） and NO in the ALI/ARDS can also add to these problems. However, the profile of ET-1 and the balance of ET-1 and NO are still unknown in a VILI model. Methods Models of oleic acid induced ALl were established in dogs; these models were then randomized into three groups undergone different tidal volume （VT） mechanical ventilation, which included a VT6 group （VT equaled to 6 ml/kg body weight, positive end expiratory pressure （PEEP） equaled to 10 cmH20, n=-6）, a VT10 group （VT equaled to 10 ml/kg body weight, PEEP equaled to 10 cmH20, n=-4） and a VT20 group （VT equaled to 20 ml/kg body weight, PEEP equaled to 10 cmH20, n=-6） for 6-hour ventilation. The levels of ET-1 and NO in serum and tissue homogenates of lung were observed throughout the trial. Results PaO2 was increased after mechanical ventilation, but hypercapnia occurred in the VT6 group. The magnitudes of lung injury in the VT20 group were more severe than those in the VT6 group and the VT10 group. Serum levels of ET-1 and NO increased after ALl models were established and slightly decreased after a 6-hour ventilation in both the VT6 group and the VT20 group. The serum ET-1 level in the VT20 group was higher than that in the VT6 group and the VT10 group after the 6-hour ventilation （P 〈0.05） while the serum NO levels were similar in the three groups （all P 〉0.05）. There was no significant difference in serum ratio of ET-1/NO between any two out of three groups （P 〉0.05）, although there was a significant positive relationship between serum ET-1 and serum NO （r=0.80, P 〈0.01）. The levels of ET-1 and NO in the lung were increased after ventilation. The lung ET-1 level in the VT20 group was significantly higher than that in the VT6 group and VT10 group （both P 〈0.05） while there was no significant di

关键词： acute lung injury tidal volume positive end expiratory pressure hypercapnia nitric oxide endothelin-1 ventilator-induced lung injury

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A Non-Blinded, Case Controlled Pilot Study to Evaluate a Novel Mask Ventilation Technique in Patients with Established Risk Factors for Difficult Mask Ventilation

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Open Journal of Anesthesiology 2016年第10期6卷 165-174页

作者： Dennis Grech David Kam Gregory Bryan Harry Israel Alex Bekker Department of Anesthesia and Perioperative Care Rutgers New Jersey Medical School Newark NJ USA Department of Anesthesiology Albert Einstein College of Medicine Montefiore Medical Center Bronx NY USA

Traditionally, there are two main methods of mask placement during face mask ventilation: one handed (CE) grip and two handed grip (THT). One handed grip is limited by air leaks between mask and patients face on the side opposite to stabilizing hand. Two handed grips provide protection against air leak but require second provider to deliver tidal volumes when using a self inflating bag or anesthesia circuit on manual ventilation. This study introduces modified CE grip which creates a firm seal at patient’s face on both sides of mask, enabling adequate tidal volume delivery with provider’s second hand. Using left hand, provider places the fifth digit along inferior border of body of left mandible. The fourth digit is placed along inferior border of body right mandible. Standing 6 inches to the left and immediately behind a supine patient on an OR table, provider rotates clockwise 45 degrees at hip, keeping elbow against their body, and lifts patient’s chin to 45 degrees. Rotational force at hip augments hand strength while tilting chin. The thumb applies pressure along left border of facemask, and the second and third digits apply pressure to right border of facemask. Methods: Patients with known predictors of difficult mask ventilation (Edentulous, bearded, Obstructive sleep apnea (OSA), mallampati 3 or 4) were in experimental group. Normal patients assigned as Controls. After induction of general anesthesia, provider ventilated patient using adult sized facemask. The anesthesia ventilator delivered standardized tidal volumes. TV, airway pressures, HR and O2 saturation were recorded after each breath. Results: All groups, except OSA, showed improvement, in tidal volumes with the novel technique compared to the traditional CE grip. Conclusion: The novel submandibular technique, an important skill, increases tidal volumes during mask ventilation for certain high risk patients.

关键词： Mask Ventilation CE Grip tidal volume Airway Skills

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