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Editorial
. 2023 Sep 1;139(3):239-243.
doi: 10.1097/ALN.0000000000004665.

Pressure for High Positive End-expiratory Pressure in Obese Surgical Patients Is Growing

Hermann Wrigge  1 , David Petroff  2 , Ana Fernandez-Bustamante  3
Affiliations
Editorial

Pressure for High Positive End-expiratory Pressure in Obese Surgical Patients Is Growing

Hermann Wrigge et al. Anesthesiology. .
No abstract available

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Conflict of interest statement

Conflict of interest statement: HW received lecture fees from Getinge, Rastatt, Germany; MSD, Konstanz, Germany; advisory honorary from Liberate Medical, KY, USA.

Figures

Figure 1:
Figure 1:
Schematic diagram of airway pressure (PAW) and gas flow (V˙) versus time during constant-flow volume controlled mechanical ventilation. Note that, after cessation of inspiratory flow, PAW decreases from peak (Ppeak) to plateau (Pplat) airway pressure during the end-inspiratory flow pause. The difference Ppeak – Pplat is due to the resistive load mainly caused by the endotracheal tube resistance in intubated, lung-healthy patients during anesthesia. Ppeak is measured at airway opening and, thus, does not include the downstream pressure in the alveolar level, which makes it less clinically relevant. Pplat reflects mean alveolar pressure, if it is measured after a sufficient inspiratory pause that ensures zero flow conditions (usually >0.2 s). Static compliance of the respiratory system (CRS) -calculation is the gold standard, requiring the measurement of Pplat, whereas dynamic CRS -calculation uses Ppeak for pragmatic reasons reflecting both, elastic and resistive loads. Cdyn: dynamic compliance of the respiratory system, PEEP: positive end-expiratory pressure, VT: tidal volume.
Figure 2:
Figure 2:
Representative examples of a typical anesthesia ventilator screen. Static compliance of the respiratory system reflects the relationship between change in volume and pressure of the respiratory system over a breath with no movement of gas. It is the accepted standard respiratory system mechanics parameter during mechanical ventilation. If plateau pressure is not available, dynamic compliance of the respiratory system can be used, but dynamic compliance will likely be lower than static compliance, and it will be more influenced than static compliance by changes in airway resistance (e.g., inspiratory duration secondary to increase in respiratory rate and thus gas flow) than static compliance. In the example, the respiratory rate change from 20 to 10 breaths per minute leads to a minimal increase in static compliance (by 3 ml/cm H2O since the end-inspiratory pause was short) but a more substantial increase in dynamic compliance (by 8 ml/cm H2O). Using the dynamic compliance would give an overestimate of the improvement of respiratory system compliance caused by the respiratory rate (and gas flow) change. PEEP, positive end-expiratory pressure.
See this image and copyright information in PMC

Comment on

References

    1. Li X, Liu H, Wang J, Ni ZL, Liu ZX, Jiao JL, Han Y, Cao JL: Individualized positive end-expiratory pressure on postoperative atelectasis in patients with obesity: a randomized controlled clinical trial. Anesthesiology 2023, in press. - PubMed
    1. Boesing C, Schaefer L, Hammel M, Otto M, Blank S, Pelosi P, Rocco PRM, Luecke T, Krebs J: Individualized positive end-expiratory pressure titration strategies in superobese patients undergoing laparoscopic surgery: prospective and non-randomized crossover study. Anesthesiology 2023, in press. - PubMed
    1. Jones RL, Nzekwu M-MU: The Effects of Body Mass Index on Lung Volumes. Chest 2006; 130:827–33 - PubMed
    1. Nestler C, Simon P, Petroff D, Hammermüller S, Kamrath D, Wolf S, Dietrich A, Camilo LM, Beda A, Carvalho AR, Giannella-Neto A, Reske AW, Wrigge H: Individualized positive end-expiratory pressure in obese patients during general anaesthesia: a randomized controlled clinical trial using electrical impedance tomography. Brit J Anaesth 2017; 119:1194–205 - PubMed
    1. Güldner A, Kiss T, Neto AS, Hemmes SNT, Canet J, Spieth PM, Rocco PRM, Schultz MJ, Pelosi P, Abreu MG de: Intraoperative Protective Mechanical Ventilation for Prevention of Postoperative Pulmonary Complications. Anesthesiology 2015; 123:692–713 - PubMed

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