The effects of lung recruitment on the phase III slope of volumetric capnography in morbidly obese patients

Autores
Bohm, Stephan H.; Maisch, Stefan; Von Sandersleben, Alexandra; Thamm, Oliver; Martinez Arca, Jorge; Tusman, Gerardo
Año de publicación
2008
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
In this study, we analyzed the effect of the alveolar recruitment strategy (ARS) and positive end-expiratory pressure (PEEP) titration on Phase III slope (S III) of volumetric capnography (VC) in morbidly obese patients. METHODS: Eleven anesthetized morbidly obese patients were studied. Lungs were ventilated with tidal volumes of 10 mL · kg−1, respiratory rates of 12–14 bpm, inspiration:expiration ratio of 1:2, and Fio2 of 0.4. ARS was performed by increasing PEEP in steps of five from 0 end-expiratory pressure to 15 cm H2O. During lung recruitment, plateau pressure was limited to 50 cm H2O, whereas tidal volume was increased to the ventilator’s maximum value of 1400 mL, and PEEP was increased to 20 cm H2O for 2 min. Thereafter, PEEP was reduced in steps of 5 cm H2O, from 15 to 0. VC, arterial blood gases, and lung mechanics data were determined for each PEEP step. RESULTS: S III decreased from 0.014 ± 0.006 to 0.005 ± 0.005 mm Hg/mL when 0 end-expiratory pressure was compared against 15 cm H2O of PEEP after ARS (15ARS, P < 0.05). This decrement in S III was accompanied by increases in Pao2 (27%, P < 0.002) and compliance (32%, P < 0.001), whereas Paco2 decreased by 8% (P < 0.038) when comparing values before and after ARS. A good prediction of the lung recruitment effect by S III was derived from the receiver operating characteristic curve analysis (area under the curve of 0.81, sensitivity of 0.75, and specificity of 0.74; P < 0.001). CONCLUSION: The S III in VC was useful to detect the optimal level of PEEP after lung recruitment in anesthetized morbidly obese patients.
Fil: Bohm, Stephan H.. University Hospital; Alemania
Fil: Maisch, Stefan. University Hospital; Alemania
Fil: Von Sandersleben, Alexandra. University Hospital; Alemania
Fil: Thamm, Oliver. University of Witten/Herdecke; Alemania
Fil: Martinez Arca, Jorge. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y Tecnología de Materiales. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Instituto de Investigaciones en Ciencia y Tecnología de Materiales; Argentina
Fil: Tusman, Gerardo. Fundación Medica de Mar del Plata. Hospital Privado de Comunidad; Argentina
Materia
Volumetric Capnography
Phase Iii Slope
Lung Recruitment
Optimun Peep
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/34951

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network_name_str CONICET Digital (CONICET)
spelling The effects of lung recruitment on the phase III slope of volumetric capnography in morbidly obese patientsBohm, Stephan H.Maisch, StefanVon Sandersleben, AlexandraThamm, OliverMartinez Arca, JorgeTusman, GerardoVolumetric CapnographyPhase Iii SlopeLung RecruitmentOptimun Peephttps://purl.org/becyt/ford/2.6https://purl.org/becyt/ford/2In this study, we analyzed the effect of the alveolar recruitment strategy (ARS) and positive end-expiratory pressure (PEEP) titration on Phase III slope (S III) of volumetric capnography (VC) in morbidly obese patients. METHODS: Eleven anesthetized morbidly obese patients were studied. Lungs were ventilated with tidal volumes of 10 mL · kg−1, respiratory rates of 12–14 bpm, inspiration:expiration ratio of 1:2, and Fio2 of 0.4. ARS was performed by increasing PEEP in steps of five from 0 end-expiratory pressure to 15 cm H2O. During lung recruitment, plateau pressure was limited to 50 cm H2O, whereas tidal volume was increased to the ventilator’s maximum value of 1400 mL, and PEEP was increased to 20 cm H2O for 2 min. Thereafter, PEEP was reduced in steps of 5 cm H2O, from 15 to 0. VC, arterial blood gases, and lung mechanics data were determined for each PEEP step. RESULTS: S III decreased from 0.014 ± 0.006 to 0.005 ± 0.005 mm Hg/mL when 0 end-expiratory pressure was compared against 15 cm H2O of PEEP after ARS (15ARS, P < 0.05). This decrement in S III was accompanied by increases in Pao2 (27%, P < 0.002) and compliance (32%, P < 0.001), whereas Paco2 decreased by 8% (P < 0.038) when comparing values before and after ARS. A good prediction of the lung recruitment effect by S III was derived from the receiver operating characteristic curve analysis (area under the curve of 0.81, sensitivity of 0.75, and specificity of 0.74; P < 0.001). CONCLUSION: The S III in VC was useful to detect the optimal level of PEEP after lung recruitment in anesthetized morbidly obese patients.Fil: Bohm, Stephan H.. University Hospital; AlemaniaFil: Maisch, Stefan. University Hospital; AlemaniaFil: Von Sandersleben, Alexandra. University Hospital; AlemaniaFil: Thamm, Oliver. University of Witten/Herdecke; AlemaniaFil: Martinez Arca, Jorge. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y Tecnología de Materiales. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Instituto de Investigaciones en Ciencia y Tecnología de Materiales; ArgentinaFil: Tusman, Gerardo. Fundación Medica de Mar del Plata. Hospital Privado de Comunidad; ArgentinaLippincott Williams2008-11-13info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/34951Bohm, Stephan H.; Maisch, Stefan; Von Sandersleben, Alexandra; Thamm, Oliver; Martinez Arca, Jorge; et al.; The effects of lung recruitment on the phase III slope of volumetric capnography in morbidly obese patients; Lippincott Williams; Anesthesia And Analgesia; 109; 1; 13-11-2008; 151-1590003-2999CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/url/https://journals.lww.com/anesthesia-analgesia/Abstract/2009/07000/The_Effects_of_Lung_Recruitment_on_the_Phase_III.26.aspxinfo:eu-repo/semantics/altIdentifier/doi/10.1213/ane.0b013e31819bcbb5info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-09-29T10:41:07Zoai:ri.conicet.gov.ar:11336/34951instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982025-09-29 10:41:07.401CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv The effects of lung recruitment on the phase III slope of volumetric capnography in morbidly obese patients
title The effects of lung recruitment on the phase III slope of volumetric capnography in morbidly obese patients
spellingShingle The effects of lung recruitment on the phase III slope of volumetric capnography in morbidly obese patients
Bohm, Stephan H.
Volumetric Capnography
Phase Iii Slope
Lung Recruitment
Optimun Peep
title_short The effects of lung recruitment on the phase III slope of volumetric capnography in morbidly obese patients
title_full The effects of lung recruitment on the phase III slope of volumetric capnography in morbidly obese patients
title_fullStr The effects of lung recruitment on the phase III slope of volumetric capnography in morbidly obese patients
title_full_unstemmed The effects of lung recruitment on the phase III slope of volumetric capnography in morbidly obese patients
title_sort The effects of lung recruitment on the phase III slope of volumetric capnography in morbidly obese patients
dc.creator.none.fl_str_mv Bohm, Stephan H.
Maisch, Stefan
Von Sandersleben, Alexandra
Thamm, Oliver
Martinez Arca, Jorge
Tusman, Gerardo
author Bohm, Stephan H.
author_facet Bohm, Stephan H.
Maisch, Stefan
Von Sandersleben, Alexandra
Thamm, Oliver
Martinez Arca, Jorge
Tusman, Gerardo
author_role author
author2 Maisch, Stefan
Von Sandersleben, Alexandra
Thamm, Oliver
Martinez Arca, Jorge
Tusman, Gerardo
author2_role author
author
author
author
author
dc.subject.none.fl_str_mv Volumetric Capnography
Phase Iii Slope
Lung Recruitment
Optimun Peep
topic Volumetric Capnography
Phase Iii Slope
Lung Recruitment
Optimun Peep
purl_subject.fl_str_mv https://purl.org/becyt/ford/2.6
https://purl.org/becyt/ford/2
dc.description.none.fl_txt_mv In this study, we analyzed the effect of the alveolar recruitment strategy (ARS) and positive end-expiratory pressure (PEEP) titration on Phase III slope (S III) of volumetric capnography (VC) in morbidly obese patients. METHODS: Eleven anesthetized morbidly obese patients were studied. Lungs were ventilated with tidal volumes of 10 mL · kg−1, respiratory rates of 12–14 bpm, inspiration:expiration ratio of 1:2, and Fio2 of 0.4. ARS was performed by increasing PEEP in steps of five from 0 end-expiratory pressure to 15 cm H2O. During lung recruitment, plateau pressure was limited to 50 cm H2O, whereas tidal volume was increased to the ventilator’s maximum value of 1400 mL, and PEEP was increased to 20 cm H2O for 2 min. Thereafter, PEEP was reduced in steps of 5 cm H2O, from 15 to 0. VC, arterial blood gases, and lung mechanics data were determined for each PEEP step. RESULTS: S III decreased from 0.014 ± 0.006 to 0.005 ± 0.005 mm Hg/mL when 0 end-expiratory pressure was compared against 15 cm H2O of PEEP after ARS (15ARS, P < 0.05). This decrement in S III was accompanied by increases in Pao2 (27%, P < 0.002) and compliance (32%, P < 0.001), whereas Paco2 decreased by 8% (P < 0.038) when comparing values before and after ARS. A good prediction of the lung recruitment effect by S III was derived from the receiver operating characteristic curve analysis (area under the curve of 0.81, sensitivity of 0.75, and specificity of 0.74; P < 0.001). CONCLUSION: The S III in VC was useful to detect the optimal level of PEEP after lung recruitment in anesthetized morbidly obese patients.
Fil: Bohm, Stephan H.. University Hospital; Alemania
Fil: Maisch, Stefan. University Hospital; Alemania
Fil: Von Sandersleben, Alexandra. University Hospital; Alemania
Fil: Thamm, Oliver. University of Witten/Herdecke; Alemania
Fil: Martinez Arca, Jorge. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y Tecnología de Materiales. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Instituto de Investigaciones en Ciencia y Tecnología de Materiales; Argentina
Fil: Tusman, Gerardo. Fundación Medica de Mar del Plata. Hospital Privado de Comunidad; Argentina
description In this study, we analyzed the effect of the alveolar recruitment strategy (ARS) and positive end-expiratory pressure (PEEP) titration on Phase III slope (S III) of volumetric capnography (VC) in morbidly obese patients. METHODS: Eleven anesthetized morbidly obese patients were studied. Lungs were ventilated with tidal volumes of 10 mL · kg−1, respiratory rates of 12–14 bpm, inspiration:expiration ratio of 1:2, and Fio2 of 0.4. ARS was performed by increasing PEEP in steps of five from 0 end-expiratory pressure to 15 cm H2O. During lung recruitment, plateau pressure was limited to 50 cm H2O, whereas tidal volume was increased to the ventilator’s maximum value of 1400 mL, and PEEP was increased to 20 cm H2O for 2 min. Thereafter, PEEP was reduced in steps of 5 cm H2O, from 15 to 0. VC, arterial blood gases, and lung mechanics data were determined for each PEEP step. RESULTS: S III decreased from 0.014 ± 0.006 to 0.005 ± 0.005 mm Hg/mL when 0 end-expiratory pressure was compared against 15 cm H2O of PEEP after ARS (15ARS, P < 0.05). This decrement in S III was accompanied by increases in Pao2 (27%, P < 0.002) and compliance (32%, P < 0.001), whereas Paco2 decreased by 8% (P < 0.038) when comparing values before and after ARS. A good prediction of the lung recruitment effect by S III was derived from the receiver operating characteristic curve analysis (area under the curve of 0.81, sensitivity of 0.75, and specificity of 0.74; P < 0.001). CONCLUSION: The S III in VC was useful to detect the optimal level of PEEP after lung recruitment in anesthetized morbidly obese patients.
publishDate 2008
dc.date.none.fl_str_mv 2008-11-13
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/34951
Bohm, Stephan H.; Maisch, Stefan; Von Sandersleben, Alexandra; Thamm, Oliver; Martinez Arca, Jorge; et al.; The effects of lung recruitment on the phase III slope of volumetric capnography in morbidly obese patients; Lippincott Williams; Anesthesia And Analgesia; 109; 1; 13-11-2008; 151-159
0003-2999
CONICET Digital
CONICET
url http://hdl.handle.net/11336/34951
identifier_str_mv Bohm, Stephan H.; Maisch, Stefan; Von Sandersleben, Alexandra; Thamm, Oliver; Martinez Arca, Jorge; et al.; The effects of lung recruitment on the phase III slope of volumetric capnography in morbidly obese patients; Lippincott Williams; Anesthesia And Analgesia; 109; 1; 13-11-2008; 151-159
0003-2999
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/url/https://journals.lww.com/anesthesia-analgesia/Abstract/2009/07000/The_Effects_of_Lung_Recruitment_on_the_Phase_III.26.aspx
info:eu-repo/semantics/altIdentifier/doi/10.1213/ane.0b013e31819bcbb5
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.format.none.fl_str_mv application/pdf
application/pdf
application/pdf
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dc.publisher.none.fl_str_mv Lippincott Williams
publisher.none.fl_str_mv Lippincott Williams
dc.source.none.fl_str_mv reponame:CONICET Digital (CONICET)
instname:Consejo Nacional de Investigaciones Científicas y Técnicas
reponame_str CONICET Digital (CONICET)
collection CONICET Digital (CONICET)
instname_str Consejo Nacional de Investigaciones Científicas y Técnicas
repository.name.fl_str_mv CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas
repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
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