Impact of changes of positive end-expiratory pressure on functional residual capacity at low tidal volume ventilation during general anesthesia

• Published in: Journal of anesthesia Vol. 26; no. 5; pp. 664 - 669
• Main Authors: Satoh, Daizoh, Kurosawa, Shin, Kirino, Wakaba, Wagatsuma, Toshihiro, Ejima, Yutaka, Yoshida, Akiko, Toyama, Hiroaki, Nagaya, Kei
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.10.2012; Springer
• Subjects: Abdomen - surgery; Aged; Analysis; Anesthesia; Anesthesia, General - methods; Anesthesiology; Blood gases; Critical Care Medicine; Emergency Medicine; Female; Functional Residual Capacity - physiology; Health aspects; Heart beat; Hemodynamics; Humans; Intensive; Lung - metabolism; Lung - physiology; Male; Medicine; Medicine & Public Health; Original; Original Article; Oxygen - metabolism; Pain Medicine; Patient compliance; Positive-Pressure Respiration - methods; Pulmonary Gas Exchange - physiology; Respiration; Respiration, Artificial - methods; Tidal Volume - physiology; Japan; General anesthesia; Low tidal volume ventilation; Positive end-expiratory pressure; Functional residual capacity
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-012-1411-9

Purpose Several reports in the literature have described the effects of positive end-expiratory pressure (PEEP) level upon functional residual capacity (FRC) in ventilated patients during general anesthesia. This study compares FRC in mechanically low tidal volume ventilation with different PEEP levels during upper abdominal surgery. Methods Before induction of anesthesia (awake) for nine patients with upper abdominal surgery, a tight-seal facemask was applied with 2 cmH 2 O pressure support ventilation and 100 % O 2 during FRC measurements conducted on patients in a supine position. After tracheal intubation, lungs were ventilated with bilevel airway pressure with a volume guarantee (7 ml/kg predicted body weight) and with an inspired oxygen fraction (FIO 2 ) of 0.4. PEEP levels of 0, 5, and 10 cmH 2 O were used. Each level of 5 and 10 cmH 2 O PEEP was maintained for 2 h. FRC was measured at each PEEP level. Results FRC awake was significantly higher than that at PEEP 0 cmH 2 O ( P  < 0.01). FRC at PEEP 0 cmH 2 O was significantly lower than that at 10 cmH 2 O ( P  < 0.01). PaO 2 /FIO 2 awake was significantly higher than that for PEEP 0 cmH 2 O ( P  < 0.01). PaO 2 /FIO 2 at PEEP 0 cmH 2 O was significantly lower than that for PEEP 5 cmH 2 O or PEEP 10 cmH 2 O ( P  < 0.01). Furthermore, PEEP 0 cmH 2 O, PEEP 5 cmH 2 O after 2 h, and PEEP 10 cmH 2 O after 2 h were correlated with FRC ( R  = 0.671, P  < 0.01) and PaO 2 /FIO 2 ( R  = 0.642, P  < 0.01). Conclusions Results suggest that PEEP at 10 cmH 2 O is necessary to maintain lung function if low tidal volume ventilation is used during upper abdominal surgery.