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. 2012 Oct;26(5):664-9.
doi: 10.1007/s00540-012-1411-9. Epub 2012 May 15.

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

Daizoh Satoh  1 , Shin Kurosawa, Wakaba Kirino, Toshihiro Wagatsuma, Yutaka Ejima, Akiko Yoshida, Hiroaki Toyama, Kei Nagaya
Affiliations

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

Daizoh Satoh et al. J Anesth. 2012 Oct.

Abstract

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.

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Figures

Fig. 1
Fig. 1
Schematic protocol used for this study. PS pressure support ventilation, FRC functional residual capacity, ABG arterial blood gases, TV tidal volume, PEEP positive end-expiratory pressure. Predicted body weight: men, 49.9 + 0.91 [height (cm), 152.4]; women, 45.4 + 0.91 [height (cm), 152.4]
Fig. 2
Fig. 2
Functional residual capacity for PEEP levels studied. **P < 0.01 versus preoperative (pre-op) and opeP0, ++ P < 0.01 versus opeP5.1, ## P < 0.01 versus opeP5.2 pre-induction (pre-ind). P postoperative, FRC measured pre-ind FRC − mask dead space (100 ml)
Fig. 3
Fig. 3
PaO2/FIO2 for PEEP levels studied. **P < 0.01 versus pre-op and opeP0, ++ P < 0.01 versus opeP5.1
Fig. 4
Fig. 4
PEEP levels at opeP0, opeP5.2, and opeP10.2 were correlated with FRC (R = 0.671, P < 0.01) and PaO2/FIO2 (R = 0.642, P < 0.01)
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