Pron pozisyonda PEEP uygulamasının solunum mekaniği ve arteriyel oksijenizasyon üzerine etkileri

Pelin Dinçer; Murat Ünsel; Cengiz Yumru

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Year 2013, Volume: 26 Issue: 3, 146 - 150, 30.09.2015

Abstract

Objectives: To evaluate the changes in arterial oxygenation and vital parameters by applying 10cm HO positive end-expiratory pressure (PEEP) to patients undergoing lumbar spine surgery in the prone position. Patients and Method: According to The American Society of Anesthesiologists (ASA) status I-II, 40 patients, scheduled for lumbar discectomy in the prone position were enrolled in the study. During the anesthesia induction and after intubation they were ventilated with intermittent positive pressure ventilation (IPPV) mode, 60%NO-40%O, 4L.min flow and 0.7-1.0 minumum alveolar concentration (MAC) sevoflurane. The patients were randomized into 2 groups. PEEP value was set at 0 cm HO in PEEP 0 group and at 10 cm HO in PEEP 10 group. Respiratory rate 10/min, inspiration-expiration ratio 1:2 and tidal volume 8ml.kgwere kept constant. Blood gas samples were obtained 10 min after induction and 15-30-45-60-75-90 min after prone positioning. Vital parameters, dynamic compliance and side effects were recorded. Results: Mean blood pressure was statistically low in PEEP 10 group at the prone positioning, compared to the other periods (p<0.05). Pulse rate in both groups was significantly low during the prone period compared to other periods (p<0.05). PaO and compliance were statistically high in PEEP10 group at the prone position as compared to the PEEP 0 group (p<0.05).Conclusion: In our opinion, applying 10 cm HO PEEP to patients undergoing spine surgery in the prone position is a beneficial implementation.

Keywords

PEEP, Prone positioning, Respiratory mechanics, Oxygenation, Peroperative ventilation

References

1. Hedenstierna G, Rothen HU. Atelectasis formation during anesthesia: causes and measures to prevent it. J Clin Monit Comput 2000;16:329- 35. doi: 10.1023/A:1011491231934
2. Hedenstierna G, Edmark L. Mechanisms of atelectasis in the perioperative period. Best Pract Res Clin Anaesthesiol 2010;24:157- 69.
3. Tusman G, Böhm SH, Warner DO, Sprung J. Atelectasis and perioperative pulmonary complications in high-risk patients. Curr Opin Anaesthesiol 2012;25:1-10. doi: 10.1097/ACO.0b013e32834dd1eb
4. Marini JJ, Hotchkiss Jr JR. PEEP in Prone position: reversing the perfusion imbalance. Crit Care Med 1999;27:1-2.
5. Satoh D, Kurosawa S, Kirino W, et al. Impact of changes of positive end-expiratory pressure on functional resudual capacity at low tidal volume ventilation during general anesthesia. J Anesth 2012 ;26:664- 9. doi: 10.1007/s00540-012-1411-9.
6. Karsten J, Heinze H, Meier T. Impact of PEEP during laparoscopic surgery on early postoperative ventilation distribution visualised by electrical impedance tomography. Minerva Anestesiol 2013;23. [Epub ahead of print]
7. Gattinoni L, Tognoni G, Pesenti A, et al. Prone-Supine Study Group. Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med 2001 ;345:568-73. doi: 10.1056/ NEJMoa010043
8. Soo Hoo GW. In prone ventilation, one good turn deserves another. N Engl J Med 2013 ;368:2227-8. doi: 10.1056/NEJMe1304349. Epub 2013 May 20.
9. Pullen RL Jr. Performing a modified Allen test. Nursing 2005 ;35:26-
10. Ruengsakulrach P, Brooks M, Hare DL, Gordon I, Buxton BF. Preoperative assessment of hand circulation by mean of Doppler ultrasonography and the modified Allen test. J Thorac Cardiovasc Surg 2001 ;121:526-31. doi: 10.1067/mtc.2001.112468
11. Pelosi P, Croci M, Calappi E, et al. Prone position improves pulmonary function in obese patients during general anesthesia. Anesth Analg 1996 ; 83:578-83.
12. Pelosi P, Ravagnan I, Giurati G, et al. Positive end-expiratory pressure improves respiratory function in obese but not in normal subjects during anesthesia and paralysis. Anesthesiology 1999 ; 91:1221-31.
13. Pelosi P, Caironi P, Taccone P, Brazzi L Pathophysiology of prone positioning in the healthy lung and in ALI/ARDS. Minerva Anestesiol 2001 ;67:238-47.
14. Kraut EJ, Amira S, Ronald B, Bruce MW. Impairment of cardiac performance by laparoscopy in patients receiving positive endexpiratory pressure. Arch Surg 1999;134:76-80. doi:10.1001/ archsurg.134.1.76
15. Kararmaz A, Kaya S, Turhanoğlu S, Özyılmaz MA. Laparoskopi sonrasında uygulanan rekruitment manevrasının arteryel oksijenasyon ve akciğer kompliyansına etkileri. Türk Anesteziyoloji ve Reanimasyon Derneği Dergisi 2004; 32: 113-9.
16. Pelosi P, Croci M, Calappi E, et al. The prone position during general anesthesia minimally affects respiratory mechanics while improving functional residual capacity and increasing oxygen tension. Anesth Analg 1995;80:955-60.
17. Wahba RW, Tessler MJ, Kardash KJ. Carbon dioxide tensions during anesthesia in the prone position. Anesth Analg 1998 ; 86:668-9.
18. Grenier B, Verchere E, Mesli A, et al. Capnography monitoring during neurosurgery: reliability in relation to various intraoperative positions. Anesth Analg 1999;88:43-8.
19. Wadsworth R, Anderton JM, Vohra A. The effect of four different surgical prone position on cardiovascular parameters in healthy volunteers. Anaesthesia 1996 ;51:819-22.
20. Wu CY, Lee TS, Chan KC, Jeng CS, Cheng YJ. Does targeted preload optimisation by stroke volume variation attenuate a reduction in cardiac output in the prone position. Anaesthesia 2012 ;67:760-4. doi: 10.1111/j.1365-2044.2012.07116.x.

Pron pozisyonda PEEP uygulamasının solunum mekaniği ve arteriyel oksijenizasyon üzerine etkileri

Year 2013, Volume: 26 Issue: 3, 146 - 150, 30.09.2015

Pelin Dinçer Murat Ünsel Cengiz Yumru

Abstract

Amaç: Çalışmamızın amacı pron pozisyonda cerrahi girişim
geçirecek lumber diskopatili hastalarda 10cm H2
O ekspirasyon
sonu pozitif basınç (positive end-expiratory pressure (PEEP))
uygulamasının arteriyel oksijenizasyon, solunum mekaniği ve
dolaşım sistemi üzerindeki etkilerini araştırmaktır.
Hastalar ve Yöntem: Pron pozisyonda lumber diskektomi
operasyonu geçirecek Amerikan Anesteziyoloji Derneği (The
American Society of Anesthesiologists (ASA)) kriterlerine göre
I-II sınıf, 40 hasta çalışmaya alındı. Anestezi indüksiyonu ve
endotrakeal entübasyondan sonra hastalar aralıklı pozitif basınçlı
ventilasyon (intermittent positive pressure ventilation (IPPV))
modunda %60 N2
O-%40 O2
, akım 4L.dk-1 ve sevoflurane 0.7-
1.0 minimum alveolar konsantrasyon (MAK) olacak şekilde
ventile edildi. Hastalar randomize edilerek 2 gruba ayrıldı. PEEP
0 grubunda, PEEP 0 cm H2
O, PEEP 10 grubunda, PEEP 10 cm
H2
O olarak ayarlandı. Solunum sayısı 10 soluk/dk, inspirasyonekspirasyon
oranı 1:2, tidal volüm 8ml.kg-1 olacak şekilde sabit
tutuldu. İndüksiyondan 10 dk, pron pozisyona döndükten sonra
15-30-45-60-75-90. dakikalarda kan gazı örnekleri alındı. Vital
parametreler, dinamik kompliyans değerleri ve yan etkiler
kaydedildi.
Bulgular: Ortalama kan basıncı değerleri PEEP 10 grubunda
pron dönemde diğer dönemlere göre istatistiksel olarak düşük
bulundu (p

Keywords

PEEP, Pron pozisyon, Solunum mekaniği, Oksijenizasyon, Peroperatif ventilasyon

References

1. Hedenstierna G, Rothen HU. Atelectasis formation during anesthesia: causes and measures to prevent it. J Clin Monit Comput 2000;16:329- 35. doi: 10.1023/A:1011491231934
2. Hedenstierna G, Edmark L. Mechanisms of atelectasis in the perioperative period. Best Pract Res Clin Anaesthesiol 2010;24:157- 69.
3. Tusman G, Böhm SH, Warner DO, Sprung J. Atelectasis and perioperative pulmonary complications in high-risk patients. Curr Opin Anaesthesiol 2012;25:1-10. doi: 10.1097/ACO.0b013e32834dd1eb
4. Marini JJ, Hotchkiss Jr JR. PEEP in Prone position: reversing the perfusion imbalance. Crit Care Med 1999;27:1-2.
5. Satoh D, Kurosawa S, Kirino W, et al. Impact of changes of positive end-expiratory pressure on functional resudual capacity at low tidal volume ventilation during general anesthesia. J Anesth 2012 ;26:664- 9. doi: 10.1007/s00540-012-1411-9.
6. Karsten J, Heinze H, Meier T. Impact of PEEP during laparoscopic surgery on early postoperative ventilation distribution visualised by electrical impedance tomography. Minerva Anestesiol 2013;23. [Epub ahead of print]
7. Gattinoni L, Tognoni G, Pesenti A, et al. Prone-Supine Study Group. Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med 2001 ;345:568-73. doi: 10.1056/ NEJMoa010043
8. Soo Hoo GW. In prone ventilation, one good turn deserves another. N Engl J Med 2013 ;368:2227-8. doi: 10.1056/NEJMe1304349. Epub 2013 May 20.
9. Pullen RL Jr. Performing a modified Allen test. Nursing 2005 ;35:26-
10. Ruengsakulrach P, Brooks M, Hare DL, Gordon I, Buxton BF. Preoperative assessment of hand circulation by mean of Doppler ultrasonography and the modified Allen test. J Thorac Cardiovasc Surg 2001 ;121:526-31. doi: 10.1067/mtc.2001.112468
11. Pelosi P, Croci M, Calappi E, et al. Prone position improves pulmonary function in obese patients during general anesthesia. Anesth Analg 1996 ; 83:578-83.
12. Pelosi P, Ravagnan I, Giurati G, et al. Positive end-expiratory pressure improves respiratory function in obese but not in normal subjects during anesthesia and paralysis. Anesthesiology 1999 ; 91:1221-31.
13. Pelosi P, Caironi P, Taccone P, Brazzi L Pathophysiology of prone positioning in the healthy lung and in ALI/ARDS. Minerva Anestesiol 2001 ;67:238-47.
14. Kraut EJ, Amira S, Ronald B, Bruce MW. Impairment of cardiac performance by laparoscopy in patients receiving positive endexpiratory pressure. Arch Surg 1999;134:76-80. doi:10.1001/ archsurg.134.1.76
15. Kararmaz A, Kaya S, Turhanoğlu S, Özyılmaz MA. Laparoskopi sonrasında uygulanan rekruitment manevrasının arteryel oksijenasyon ve akciğer kompliyansına etkileri. Türk Anesteziyoloji ve Reanimasyon Derneği Dergisi 2004; 32: 113-9.
16. Pelosi P, Croci M, Calappi E, et al. The prone position during general anesthesia minimally affects respiratory mechanics while improving functional residual capacity and increasing oxygen tension. Anesth Analg 1995;80:955-60.
17. Wahba RW, Tessler MJ, Kardash KJ. Carbon dioxide tensions during anesthesia in the prone position. Anesth Analg 1998 ; 86:668-9.
18. Grenier B, Verchere E, Mesli A, et al. Capnography monitoring during neurosurgery: reliability in relation to various intraoperative positions. Anesth Analg 1999;88:43-8.
19. Wadsworth R, Anderton JM, Vohra A. The effect of four different surgical prone position on cardiovascular parameters in healthy volunteers. Anaesthesia 1996 ;51:819-22.
20. Wu CY, Lee TS, Chan KC, Jeng CS, Cheng YJ. Does targeted preload optimisation by stroke volume variation attenuate a reduction in cardiac output in the prone position. Anaesthesia 2012 ;67:760-4. doi: 10.1111/j.1365-2044.2012.07116.x.

There are 20 citations in total.

Details

Primary Language	Turkish
Journal Section	Articles
Authors	Pelin Dinçer This is me Murat Ünsel This is me Cengiz Yumru This is me
Publication Date	September 30, 2015
Published in Issue	Year 2013 Volume: 26 Issue: 3

Cite

APA	Dinçer, P., Ünsel, M., & Yumru, C. (2015). Pron pozisyonda PEEP uygulamasının solunum mekaniği ve arteriyel oksijenizasyon üzerine etkileri. Marmara Medical Journal, 26(3), 146-150.
AMA	Dinçer P, Ünsel M, Yumru C. Pron pozisyonda PEEP uygulamasının solunum mekaniği ve arteriyel oksijenizasyon üzerine etkileri. Marmara Med J. September 2015;26(3):146-150.
Chicago	Dinçer, Pelin, Murat Ünsel, and Cengiz Yumru. “Pron Pozisyonda PEEP uygulamasının Solunum mekaniği Ve Arteriyel Oksijenizasyon üzerine Etkileri”. Marmara Medical Journal 26, no. 3 (September 2015): 146-50.
EndNote	Dinçer P, Ünsel M, Yumru C (September 1, 2015) Pron pozisyonda PEEP uygulamasının solunum mekaniği ve arteriyel oksijenizasyon üzerine etkileri. Marmara Medical Journal 26 3 146–150.
IEEE	P. Dinçer, M. Ünsel, and C. Yumru, “Pron pozisyonda PEEP uygulamasının solunum mekaniği ve arteriyel oksijenizasyon üzerine etkileri”, Marmara Med J, vol. 26, no. 3, pp. 146–150, 2015.
ISNAD	Dinçer, Pelin et al. “Pron Pozisyonda PEEP uygulamasının Solunum mekaniği Ve Arteriyel Oksijenizasyon üzerine Etkileri”. Marmara Medical Journal 26/3 (September 2015), 146-150.
JAMA	Dinçer P, Ünsel M, Yumru C. Pron pozisyonda PEEP uygulamasının solunum mekaniği ve arteriyel oksijenizasyon üzerine etkileri. Marmara Med J. 2015;26:146–150.
MLA	Dinçer, Pelin et al. “Pron Pozisyonda PEEP uygulamasının Solunum mekaniği Ve Arteriyel Oksijenizasyon üzerine Etkileri”. Marmara Medical Journal, vol. 26, no. 3, 2015, pp. 146-50.
Vancouver	Dinçer P, Ünsel M, Yumru C. Pron pozisyonda PEEP uygulamasının solunum mekaniği ve arteriyel oksijenizasyon üzerine etkileri. Marmara Med J. 2015;26(3):146-50.

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