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
- Institución
- Consejo Nacional de Investigaciones Científicas y Técnicas
- OAI Identificador
- oai:ri.conicet.gov.ar:11336/4460
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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 |
_version_ |
1844613400623054848 |
score |
13.070432 |