Multimodal non‑invasive monitoring to apply an open lung approach strategy in morbidly obese patients during bariatric surgery

"To evaluate the use of non-invasive variables for monitoring an open-lung approach (OLA) strategy in bariatric surgery. Twelve morbidly obese patients undergoing bariatric surgery received a baseline protective ventilation with 8 cmH2O of positive-end expiratory pressure (PEEP). Then, the OLA...

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Autores principales: Tusman, Gerardo, Acosta, Cecilia M., Ochoa, Marcos, Böhm, Stephan H., Gogniat, Emiliano, Martínez Arca, Jorge, Scandurra, Adriana, Madorno, Matías, Ferrando, Carlos, Suárez-Sipmann, Fernando
Formato: Artículos de Publicaciones Periódicas acceptedVersion
Lenguaje:Inglés
Publicado: 2020
Materias:
CAPNOGRAFIA
OBESIDAD
CIRUGIA BARIATRICA
PULMONES
RESPIRACION
Acceso en línea:http://ri.itba.edu.ar/handle/123456789/2222
Aporte de:
Repositorio Institucional Instituto Tecnológico de Buenos Aires (ITBA) de Instituto Tecnológico de Buenos Aires (ITBA)
id I32-R138-123456789-2222
record_format dspace
spelling I32-R138-123456789-22222022-12-07T13:06:35Z Multimodal non‑invasive monitoring to apply an open lung approach strategy in morbidly obese patients during bariatric surgery Tusman, Gerardo Acosta, Cecilia M. Ochoa, Marcos Böhm, Stephan H. Gogniat, Emiliano Martínez Arca, Jorge Scandurra, Adriana Madorno, Matías Ferrando, Carlos Suárez-Sipmann, Fernando CAPNOGRAFIA OBESIDAD CIRUGIA BARIATRICA PULMONES RESPIRACION "To evaluate the use of non-invasive variables for monitoring an open-lung approach (OLA) strategy in bariatric surgery. Twelve morbidly obese patients undergoing bariatric surgery received a baseline protective ventilation with 8 cmH2O of positive-end expiratory pressure (PEEP). Then, the OLA strategy was applied consisting in lung recruitment followed by a decremental PEEP trial, from 20 to 8 cmH2O, in steps of 2 cmH2O to find the lung’s closing pressure. Baseline ventila-tion was then resumed setting open lung PEEP (OL-PEEP) at 2 cmH2O above this pressure. The multimodal non-invasive variables used for monitoring OLA consisted in pulse oximetry (SpO2), respiratory compliance (Crs), end-expiratory lung volume measured by a capnodynamic method (EELVCO2), and esophageal manometry. OLPEEP was detected at 15.9 ± 1.7 cmH2O corresponding to a positive end-expiratory transpulmonary pressure (PL,ee) of 0.9 ± 1.1 cmH2O. ROC analysis showed that SpO2 was more accurate (AUC 0.92, IC95% 0.87–0.97) than Crs (AUC 0.76, IC95% 0.87–0.97) and EELVCO2 (AUC 0.73, IC95% 0.64–0.82) to detect the lung’s closing pressure according to the change of PL,ee from positive to negative values. Compared to baseline ventilation with 8 cmH2O of PEEP, OLA increased EELVCO2 (1309 ± 517 vs. 2177 ± 679 mL) and decreased driving pressure (18.3 ± 2.2 vs. 10.1 ± 1.7 cmH2O), estimated shunt (17.7 ± 3.4 vs. 4.2 ± 1.4%), lung strain (0.39 ± 0.07 vs. 0.22 ± 0.06) and lung elastance (28.4 ± 5.8 vs. 15.3 ± 4.3 cmH2O/L), respectively; all p < 0.0001. The OLA strategy can be monitored using noninvasive variables during bariatric surgery. This strategy decreased lung strain, elastance and driving pressure compared with standard protective ventilatory settings." 2020-06-24T19:33:48Z 2020-06-24T19:33:48Z 2019 Artículos de Publicaciones Periódicas info:eu-repo/semantics/acceptedVersion 1387-1307 http://ri.itba.edu.ar/handle/123456789/2222 en info:eu-repo/semantics/altIdentifier/doi/10.1007/s10877-019-00405-w application/pdf
institution Instituto Tecnológico de Buenos Aires (ITBA)
institution_str I-32
repository_str R-138
collection Repositorio Institucional Instituto Tecnológico de Buenos Aires (ITBA)
language Inglés
topic CAPNOGRAFIA
OBESIDAD
CIRUGIA BARIATRICA
PULMONES
RESPIRACION
spellingShingle CAPNOGRAFIA
OBESIDAD
CIRUGIA BARIATRICA
PULMONES
RESPIRACION
Tusman, Gerardo
Acosta, Cecilia M.
Ochoa, Marcos
Böhm, Stephan H.
Gogniat, Emiliano
Martínez Arca, Jorge
Scandurra, Adriana
Madorno, Matías
Ferrando, Carlos
Suárez-Sipmann, Fernando
Multimodal non‑invasive monitoring to apply an open lung approach strategy in morbidly obese patients during bariatric surgery
topic_facet CAPNOGRAFIA
OBESIDAD
CIRUGIA BARIATRICA
PULMONES
RESPIRACION
description "To evaluate the use of non-invasive variables for monitoring an open-lung approach (OLA) strategy in bariatric surgery. Twelve morbidly obese patients undergoing bariatric surgery received a baseline protective ventilation with 8 cmH2O of positive-end expiratory pressure (PEEP). Then, the OLA strategy was applied consisting in lung recruitment followed by a decremental PEEP trial, from 20 to 8 cmH2O, in steps of 2 cmH2O to find the lung’s closing pressure. Baseline ventila-tion was then resumed setting open lung PEEP (OL-PEEP) at 2 cmH2O above this pressure. The multimodal non-invasive variables used for monitoring OLA consisted in pulse oximetry (SpO2), respiratory compliance (Crs), end-expiratory lung volume measured by a capnodynamic method (EELVCO2), and esophageal manometry. OLPEEP was detected at 15.9 ± 1.7 cmH2O corresponding to a positive end-expiratory transpulmonary pressure (PL,ee) of 0.9 ± 1.1 cmH2O. ROC analysis showed that SpO2 was more accurate (AUC 0.92, IC95% 0.87–0.97) than Crs (AUC 0.76, IC95% 0.87–0.97) and EELVCO2 (AUC 0.73, IC95% 0.64–0.82) to detect the lung’s closing pressure according to the change of PL,ee from positive to negative values. Compared to baseline ventilation with 8 cmH2O of PEEP, OLA increased EELVCO2 (1309 ± 517 vs. 2177 ± 679 mL) and decreased driving pressure (18.3 ± 2.2 vs. 10.1 ± 1.7 cmH2O), estimated shunt (17.7 ± 3.4 vs. 4.2 ± 1.4%), lung strain (0.39 ± 0.07 vs. 0.22 ± 0.06) and lung elastance (28.4 ± 5.8 vs. 15.3 ± 4.3 cmH2O/L), respectively; all p < 0.0001. The OLA strategy can be monitored using noninvasive variables during bariatric surgery. This strategy decreased lung strain, elastance and driving pressure compared with standard protective ventilatory settings."
format Artículos de Publicaciones Periódicas
acceptedVersion
author Tusman, Gerardo
Acosta, Cecilia M.
Ochoa, Marcos
Böhm, Stephan H.
Gogniat, Emiliano
Martínez Arca, Jorge
Scandurra, Adriana
Madorno, Matías
Ferrando, Carlos
Suárez-Sipmann, Fernando
author_facet Tusman, Gerardo
Acosta, Cecilia M.
Ochoa, Marcos
Böhm, Stephan H.
Gogniat, Emiliano
Martínez Arca, Jorge
Scandurra, Adriana
Madorno, Matías
Ferrando, Carlos
Suárez-Sipmann, Fernando
author_sort Tusman, Gerardo
title Multimodal non‑invasive monitoring to apply an open lung approach strategy in morbidly obese patients during bariatric surgery
title_short Multimodal non‑invasive monitoring to apply an open lung approach strategy in morbidly obese patients during bariatric surgery
title_full Multimodal non‑invasive monitoring to apply an open lung approach strategy in morbidly obese patients during bariatric surgery
title_fullStr Multimodal non‑invasive monitoring to apply an open lung approach strategy in morbidly obese patients during bariatric surgery
title_full_unstemmed Multimodal non‑invasive monitoring to apply an open lung approach strategy in morbidly obese patients during bariatric surgery
title_sort multimodal non‑invasive monitoring to apply an open lung approach strategy in morbidly obese patients during bariatric surgery
publishDate 2020
url http://ri.itba.edu.ar/handle/123456789/2222
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