Noninvasive monitoring of lung recruitment maneuvers in morbidly obese patients: the role of pulse oximetry and volumetric capnography

Autores
Tusman, Gerardo; Groisman, Iván; Fiolo, Felipe E.; Scandurra, Adriana; Martinez Arca, Jorge; Krumrick, Gustavo; Bohm, Stephan H; Suarez-sipmann, Fernando
Año de publicación
2013
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
BACKGROUND: We conducted this study to determine whether pulse oximetry and volumetric capnography (VCap) can determine the opening and closing pressures of lungs of anesthetized morbidly obese patients. METHODS: Twenty morbidly obese patients undergoing laparoscopic bariatric surgery with capnoperitoneum were studied. A lung recruitment maneuver was performed in pressure control ventilation as follows: (1) During an ascending limb, the lungs? opening pressure was detected. After increasing positive end-expiratory pressure (PEEP) from 8 to 16 cm H2O, fraction of inspired oxygen (FIO2) was decreased until pulse oximetric arterial saturation (SpO2) was <92%. Thereafter, end-inspiratory pressure was increased in steps of 2 cm H2O, from 36 to a maximum of 50 cm H2O. The opening pressure was attained when SpO2 exceeded 97%. (2) During a subsequent decreasing limb, the lungs? closing pressure was identified. PEEP was decreased from 22 to 10 cm H2O in steps of 2 cm H2O. The closing pressure was determined as the PEEP value at which respiratory compliance decreased from its maximum value. We continuously recorded lung mechanics, SpO2, and VCap. RESULTS: The lungs' opening pressures were detected at 44 (4) cm H2O (median and interquartile range) and the closing pressure at 14 (2) cm H2O. Therefore, the level of PEEP that kept the lungs without collapse was found to be 16 (3) cm H2O. Using respiratory compliance as a reference, receiver operating characteristic analysis showed that SpO2 (area under the curve [AUC] 0.80 [SE 0.07], sensitivity 0.65, and specificity 0.94), the elimination of CO2 per breath (AUC 0.91 [SE 0.05], sensitivity 0.85, and specificity 0.98), and Bohr's dead space (AUC 0.83 [SE 0.06], sensitivity 0.70, and specificity 0.95] were relatively accurate for detecting lung collapse during the decreasing limb of a recruitment maneuver. CONCLUSIONS: Lung recruitment in morbidly obese patients could be effectively monitored by combining noninvasive pulse oximetry and VCap. SpO2, the elimination of CO2, and Bohr's dead space detected the individual's opening and closing pressures.
Fil: Tusman, Gerardo. Fundacion Medica de Mar del Plata. Hospital Privado de Comunidad; Argentina
Fil: Groisman, Iván. Fundacion Medica de Mar del Plata. Hospital Privado de Comunidad; Argentina
Fil: Fiolo, Felipe E.. Fundacion Medica de Mar del Plata. Hospital Privado de Comunidad; Argentina
Fil: Scandurra, Adriana. Universidad Nacional de Mar del Plata. Facultad de Ingeniería; Argentina
Fil: Martinez Arca, Jorge. Universidad Nacional de Mar del Plata. Facultad de Ingeniería; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Mar del Plata. Instituto de Investigación en Ciencia y Tecnología de Materiales (i); Argentina
Fil: Krumrick, Gustavo. Fundacion Medica de Mar del Plata; Argentina
Fil: Bohm, Stephan H. Swisstom AG; Suiza
Fil: Suarez-sipmann, Fernando. Instituto de Investigación Santinaria. Fundación Jiménez Díaz; España
Materia
Pulse Oximetry
Data Processing
Ventilation Strategies
Lung Recruitment Maneuvers
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:11336/4460

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network_acronym_str CONICETDig
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network_name_str CONICET Digital (CONICET)
spelling Noninvasive monitoring of lung recruitment maneuvers in morbidly obese patients: the role of pulse oximetry and volumetric capnographyTusman, GerardoGroisman, IvánFiolo, Felipe E.Scandurra, AdrianaMartinez Arca, JorgeKrumrick, GustavoBohm, Stephan HSuarez-sipmann, FernandoPulse OximetryData ProcessingVentilation StrategiesLung Recruitment Maneuvershttps://purl.org/becyt/ford/3.2https://purl.org/becyt/ford/3BACKGROUND: We conducted this study to determine whether pulse oximetry and volumetric capnography (VCap) can determine the opening and closing pressures of lungs of anesthetized morbidly obese patients. METHODS: Twenty morbidly obese patients undergoing laparoscopic bariatric surgery with capnoperitoneum were studied. A lung recruitment maneuver was performed in pressure control ventilation as follows: (1) During an ascending limb, the lungs? opening pressure was detected. After increasing positive end-expiratory pressure (PEEP) from 8 to 16 cm H2O, fraction of inspired oxygen (FIO2) was decreased until pulse oximetric arterial saturation (SpO2) was <92%. Thereafter, end-inspiratory pressure was increased in steps of 2 cm H2O, from 36 to a maximum of 50 cm H2O. The opening pressure was attained when SpO2 exceeded 97%. (2) During a subsequent decreasing limb, the lungs? closing pressure was identified. PEEP was decreased from 22 to 10 cm H2O in steps of 2 cm H2O. The closing pressure was determined as the PEEP value at which respiratory compliance decreased from its maximum value. We continuously recorded lung mechanics, SpO2, and VCap. RESULTS: The lungs' opening pressures were detected at 44 (4) cm H2O (median and interquartile range) and the closing pressure at 14 (2) cm H2O. Therefore, the level of PEEP that kept the lungs without collapse was found to be 16 (3) cm H2O. Using respiratory compliance as a reference, receiver operating characteristic analysis showed that SpO2 (area under the curve [AUC] 0.80 [SE 0.07], sensitivity 0.65, and specificity 0.94), the elimination of CO2 per breath (AUC 0.91 [SE 0.05], sensitivity 0.85, and specificity 0.98), and Bohr's dead space (AUC 0.83 [SE 0.06], sensitivity 0.70, and specificity 0.95] were relatively accurate for detecting lung collapse during the decreasing limb of a recruitment maneuver. CONCLUSIONS: Lung recruitment in morbidly obese patients could be effectively monitored by combining noninvasive pulse oximetry and VCap. SpO2, the elimination of CO2, and Bohr's dead space detected the individual's opening and closing pressures.Fil: Tusman, Gerardo. Fundacion Medica de Mar del Plata. Hospital Privado de Comunidad; ArgentinaFil: Groisman, Iván. Fundacion Medica de Mar del Plata. Hospital Privado de Comunidad; ArgentinaFil: Fiolo, Felipe E.. Fundacion Medica de Mar del Plata. Hospital Privado de Comunidad; ArgentinaFil: Scandurra, Adriana. Universidad Nacional de Mar del Plata. Facultad de Ingeniería; ArgentinaFil: Martinez Arca, Jorge. Universidad Nacional de Mar del Plata. Facultad de Ingeniería; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Mar del Plata. Instituto de Investigación en Ciencia y Tecnología de Materiales (i); ArgentinaFil: Krumrick, Gustavo. Fundacion Medica de Mar del Plata; ArgentinaFil: Bohm, Stephan H. Swisstom AG; SuizaFil: Suarez-sipmann, Fernando. Instituto de Investigación Santinaria. Fundación Jiménez Díaz; EspañaLippincott, Williams2013-08-29info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/4460Tusman, Gerardo; Groisman, Iván; Fiolo, Felipe E.; Scandurra, Adriana; Martinez Arca, Jorge; et al.; Noninvasive monitoring of lung recruitment maneuvers in morbidly obese patients: the role of pulse oximetry and volumetric capnography; Lippincott, Williams; Anesthesia And Analgesia; 118; 1; 29-8-2013; 137-1440003-2999enginfo:eu-repo/semantics/altIdentifier/ark/10.1213/01.ane.0000438350.29240.08info:eu-repo/semantics/altIdentifier/ark/http://journals.lww.com/anesthesia-analgesia/Fulltext/2014/01000/Noninvasive_Monitoring_of_Lung_Recruitment.16.aspxinfo:eu-repo/semantics/altIdentifier/doi/10.1213/01.ane.0000438350.29240.08info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-09-29T09:44:30Zoai:ri.conicet.gov.ar:11336/4460instacron: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 09:44:30.351CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv Noninvasive monitoring of lung recruitment maneuvers in morbidly obese patients: the role of pulse oximetry and volumetric capnography
title Noninvasive monitoring of lung recruitment maneuvers in morbidly obese patients: the role of pulse oximetry and volumetric capnography
spellingShingle Noninvasive monitoring of lung recruitment maneuvers in morbidly obese patients: the role of pulse oximetry and volumetric capnography
Tusman, Gerardo
Pulse Oximetry
Data Processing
Ventilation Strategies
Lung Recruitment Maneuvers
title_short Noninvasive monitoring of lung recruitment maneuvers in morbidly obese patients: the role of pulse oximetry and volumetric capnography
title_full Noninvasive monitoring of lung recruitment maneuvers in morbidly obese patients: the role of pulse oximetry and volumetric capnography
title_fullStr Noninvasive monitoring of lung recruitment maneuvers in morbidly obese patients: the role of pulse oximetry and volumetric capnography
title_full_unstemmed Noninvasive monitoring of lung recruitment maneuvers in morbidly obese patients: the role of pulse oximetry and volumetric capnography
title_sort Noninvasive monitoring of lung recruitment maneuvers in morbidly obese patients: the role of pulse oximetry and volumetric capnography
dc.creator.none.fl_str_mv Tusman, Gerardo
Groisman, Iván
Fiolo, Felipe E.
Scandurra, Adriana
Martinez Arca, Jorge
Krumrick, Gustavo
Bohm, Stephan H
Suarez-sipmann, Fernando
author Tusman, Gerardo
author_facet Tusman, Gerardo
Groisman, Iván
Fiolo, Felipe E.
Scandurra, Adriana
Martinez Arca, Jorge
Krumrick, Gustavo
Bohm, Stephan H
Suarez-sipmann, Fernando
author_role author
author2 Groisman, Iván
Fiolo, Felipe E.
Scandurra, Adriana
Martinez Arca, Jorge
Krumrick, Gustavo
Bohm, Stephan H
Suarez-sipmann, Fernando
author2_role author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Pulse Oximetry
Data Processing
Ventilation Strategies
Lung Recruitment Maneuvers
topic Pulse Oximetry
Data Processing
Ventilation Strategies
Lung Recruitment Maneuvers
purl_subject.fl_str_mv https://purl.org/becyt/ford/3.2
https://purl.org/becyt/ford/3
dc.description.none.fl_txt_mv BACKGROUND: We conducted this study to determine whether pulse oximetry and volumetric capnography (VCap) can determine the opening and closing pressures of lungs of anesthetized morbidly obese patients. METHODS: Twenty morbidly obese patients undergoing laparoscopic bariatric surgery with capnoperitoneum were studied. A lung recruitment maneuver was performed in pressure control ventilation as follows: (1) During an ascending limb, the lungs? opening pressure was detected. After increasing positive end-expiratory pressure (PEEP) from 8 to 16 cm H2O, fraction of inspired oxygen (FIO2) was decreased until pulse oximetric arterial saturation (SpO2) was <92%. Thereafter, end-inspiratory pressure was increased in steps of 2 cm H2O, from 36 to a maximum of 50 cm H2O. The opening pressure was attained when SpO2 exceeded 97%. (2) During a subsequent decreasing limb, the lungs? closing pressure was identified. PEEP was decreased from 22 to 10 cm H2O in steps of 2 cm H2O. The closing pressure was determined as the PEEP value at which respiratory compliance decreased from its maximum value. We continuously recorded lung mechanics, SpO2, and VCap. RESULTS: The lungs' opening pressures were detected at 44 (4) cm H2O (median and interquartile range) and the closing pressure at 14 (2) cm H2O. Therefore, the level of PEEP that kept the lungs without collapse was found to be 16 (3) cm H2O. Using respiratory compliance as a reference, receiver operating characteristic analysis showed that SpO2 (area under the curve [AUC] 0.80 [SE 0.07], sensitivity 0.65, and specificity 0.94), the elimination of CO2 per breath (AUC 0.91 [SE 0.05], sensitivity 0.85, and specificity 0.98), and Bohr's dead space (AUC 0.83 [SE 0.06], sensitivity 0.70, and specificity 0.95] were relatively accurate for detecting lung collapse during the decreasing limb of a recruitment maneuver. CONCLUSIONS: Lung recruitment in morbidly obese patients could be effectively monitored by combining noninvasive pulse oximetry and VCap. SpO2, the elimination of CO2, and Bohr's dead space detected the individual's opening and closing pressures.
Fil: Tusman, Gerardo. Fundacion Medica de Mar del Plata. Hospital Privado de Comunidad; Argentina
Fil: Groisman, Iván. Fundacion Medica de Mar del Plata. Hospital Privado de Comunidad; Argentina
Fil: Fiolo, Felipe E.. Fundacion Medica de Mar del Plata. Hospital Privado de Comunidad; Argentina
Fil: Scandurra, Adriana. Universidad Nacional de Mar del Plata. Facultad de Ingeniería; Argentina
Fil: Martinez Arca, Jorge. Universidad Nacional de Mar del Plata. Facultad de Ingeniería; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Mar del Plata. Instituto de Investigación en Ciencia y Tecnología de Materiales (i); Argentina
Fil: Krumrick, Gustavo. Fundacion Medica de Mar del Plata; Argentina
Fil: Bohm, Stephan H. Swisstom AG; Suiza
Fil: Suarez-sipmann, Fernando. Instituto de Investigación Santinaria. Fundación Jiménez Díaz; España
description BACKGROUND: We conducted this study to determine whether pulse oximetry and volumetric capnography (VCap) can determine the opening and closing pressures of lungs of anesthetized morbidly obese patients. METHODS: Twenty morbidly obese patients undergoing laparoscopic bariatric surgery with capnoperitoneum were studied. A lung recruitment maneuver was performed in pressure control ventilation as follows: (1) During an ascending limb, the lungs? opening pressure was detected. After increasing positive end-expiratory pressure (PEEP) from 8 to 16 cm H2O, fraction of inspired oxygen (FIO2) was decreased until pulse oximetric arterial saturation (SpO2) was <92%. Thereafter, end-inspiratory pressure was increased in steps of 2 cm H2O, from 36 to a maximum of 50 cm H2O. The opening pressure was attained when SpO2 exceeded 97%. (2) During a subsequent decreasing limb, the lungs? closing pressure was identified. PEEP was decreased from 22 to 10 cm H2O in steps of 2 cm H2O. The closing pressure was determined as the PEEP value at which respiratory compliance decreased from its maximum value. We continuously recorded lung mechanics, SpO2, and VCap. RESULTS: The lungs' opening pressures were detected at 44 (4) cm H2O (median and interquartile range) and the closing pressure at 14 (2) cm H2O. Therefore, the level of PEEP that kept the lungs without collapse was found to be 16 (3) cm H2O. Using respiratory compliance as a reference, receiver operating characteristic analysis showed that SpO2 (area under the curve [AUC] 0.80 [SE 0.07], sensitivity 0.65, and specificity 0.94), the elimination of CO2 per breath (AUC 0.91 [SE 0.05], sensitivity 0.85, and specificity 0.98), and Bohr's dead space (AUC 0.83 [SE 0.06], sensitivity 0.70, and specificity 0.95] were relatively accurate for detecting lung collapse during the decreasing limb of a recruitment maneuver. CONCLUSIONS: Lung recruitment in morbidly obese patients could be effectively monitored by combining noninvasive pulse oximetry and VCap. SpO2, the elimination of CO2, and Bohr's dead space detected the individual's opening and closing pressures.
publishDate 2013
dc.date.none.fl_str_mv 2013-08-29
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/11336/4460
Tusman, Gerardo; Groisman, Iván; Fiolo, Felipe E.; Scandurra, Adriana; Martinez Arca, Jorge; et al.; Noninvasive monitoring of lung recruitment maneuvers in morbidly obese patients: the role of pulse oximetry and volumetric capnography; Lippincott, Williams; Anesthesia And Analgesia; 118; 1; 29-8-2013; 137-144
0003-2999
url http://hdl.handle.net/11336/4460
identifier_str_mv Tusman, Gerardo; Groisman, Iván; Fiolo, Felipe E.; Scandurra, Adriana; Martinez Arca, Jorge; et al.; Noninvasive monitoring of lung recruitment maneuvers in morbidly obese patients: the role of pulse oximetry and volumetric capnography; Lippincott, Williams; Anesthesia And Analgesia; 118; 1; 29-8-2013; 137-144
0003-2999
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/ark/10.1213/01.ane.0000438350.29240.08
info:eu-repo/semantics/altIdentifier/ark/http://journals.lww.com/anesthesia-analgesia/Fulltext/2014/01000/Noninvasive_Monitoring_of_Lung_Recruitment.16.aspx
info:eu-repo/semantics/altIdentifier/doi/10.1213/01.ane.0000438350.29240.08
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
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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