Modes of mechanical ventilation for the operating room

被引:57
作者
Ball, Lorenzo [1 ]
Dameri, Maddalena [1 ]
Pelosi, Paolo [1 ]
机构
[1] Univ Genoa, IRCCS AOU San Martino IST, Dept Surg Sci & Integrated Diagnost, Largo Rosanna Benzi 8, I-16131 Genoa, Italy
关键词
general anaesthesia; mechanical ventilation; pressure-controlled ventilation; volume-controlled ventilation; volume guaranteed; non-invasive positive pressure ventilation; induction; preoxygenation;
D O I
10.1016/j.bpa.2015.08.003
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Most patients undergoing surgical procedures need to be mechanically ventilated, because of the impact of several drugs administered at induction and during maintenance of general anaesthesia on respiratory function. Optimization of intraoperative mechanical ventilation can reduce the incidence of post-operative pulmonary complications and improve the patient's outcome. Preoxygenation at induction of general anaesthesia prolongs the time window for safe intubation, reducing the risk of hypoxia and overweighs the potential risk of reabsorption atelectasis. Noninvasive positive pressure ventilation delivered through different interfaces should be considered at the induction of anaesthesia morbidly obese patients. Anaesthesia ventilators are becoming increasingly sophisticated, integrating many functions that were once exclusive to intensive care. Modern anaesthesia machines provide high performances in delivering the desired volumes and pressures accurately and precisely, including assisted ventilation modes. Therefore, the physicians should be familiar with the potential and pitfalls of the most commonly used intraoperative ventilation modes: volume-controlled, pressure-controlled, dual-controlled and assisted ventilation. Although there is no clear evidence to support the advantage of any one of these ventilation modes over the others, protective mechanical ventilation with low tidal volume and low levels of positive end-expiratory pressure (PEEP) should be considered in patients undergoing surgery. The target tidal volume should be calculated based on the predicted or ideal body weight rather than on the actual body weight. To optimize ventilation monitoring, anaesthesia machines should include end-inspiratory and end-expiratory pause as well as flow-volume loop curves. The routine administration of high PEEP levels should be avoided, as this may lead to haemodynamic impairment and fluid overload. Higher PEEP might be considered during surgery longer than 3 h, laparoscopy in the Trendelenburg position and in patients with body mass index >35 kg/m(2). Large randomized trials are warranted to identify subgroups of patients and the type of surgery that can potentially benefit from specific ventilation modes or ventilation settings. (C) 2015 Elsevier Ltd. All rights reserved.
引用
收藏
页码:285 / 299
页数:15
相关论文
共 63 条
[21]   Noninvasive Ventilation and Alveolar Recruitment Maneuver Improve Respiratory Function during and after Intubation of Morbidly Obese Patients A Randomized Controlled Study [J].
Futier, Emmanuel ;
Constantin, Jean-Michel ;
Pelosi, Paolo ;
Chanques, Gerald ;
Massone, Alexandre ;
Petit, Antoine ;
Kwiatkowski, Fabrice ;
Bazin, Jean-Etienne ;
Jaber, Samir .
ANESTHESIOLOGY, 2011, 114 (06) :1354-1363
[22]   Positive end-expiratory pressure during induction of general anesthesia increases duration of nonhypoxic apnea in morbidly obese patients [J].
Gander, S ;
Frascarolo, P ;
Suter, M ;
Spahn, DR ;
Magnusson, L .
ANESTHESIA AND ANALGESIA, 2005, 100 (02) :580-584
[23]   A comparison between volume-controlled ventilation and pressure-controlled ventilation in providing better oxygenation in obese patients undergoing laparoscopic cholecystectomy [J].
Gupta, Sampa Dutta ;
Kundu, Sudeshna Bhar ;
Ghose, Tapas ;
Maji, Sunanda ;
Mitra, Koel ;
Mukherjee, Maitreyee ;
Mandal, Sripurna ;
Sarbapalli, Debabrata ;
Bhattacharya, Sulagna ;
Bhattacharya, Saikat .
INDIAN JOURNAL OF ANAESTHESIA, 2012, 56 (03) :276-282
[24]   Pressure-controlled ventilation does not improve gas exchange in morbidly obese patients undergoing abdominal surgery [J].
Hans, Gregory A. ;
Pregaldien, Audrey A. ;
Kaba, Abdourahamane ;
Sottiaux, Thierry M. ;
DeRoover, Arnaud ;
Lamy, Maurice L. ;
Joris, Jean L. .
OBESITY SURGERY, 2008, 18 (01) :71-76
[25]   Continuous positive airway pressure/pressure support pre-oxygenation of morbidly obese patients [J].
Harbut, P. ;
Gozdzik, W. ;
Stjernfalt, E. ;
Marsk, R. ;
Hesselvik, J. F. .
ACTA ANAESTHESIOLOGICA SCANDINAVICA, 2014, 58 (06) :675-680
[26]   The effects of anesthesia and muscle paralysis on the respiratory system [J].
Hedenstierna, G ;
Edmark, L .
INTENSIVE CARE MEDICINE, 2005, 31 (10) :1327-1335
[27]   Respiratory Function During Anesthesia: Effects on Gas Exchange [J].
Hedenstierna, Goran ;
Rothen, Hans Ulrich .
COMPREHENSIVE PHYSIOLOGY, 2012, 2 (01) :69-96
[28]   High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial [J].
Hemmes, Sabrine N. T. ;
de Abreu, Marcelo Gama ;
Pelosi, Paolo ;
Schultz, Marcus J. ;
Severgnini, Paolo ;
Hollmann, Markus W. ;
Binnekade, Jan M. ;
Wrigge, Hermann ;
Canet, Jaume ;
Hiesmayr, Michael ;
Schmid, Werner ;
Jaber, Samir ;
Hedenstierna, Goran ;
Putensen, Christian ;
Sessler, Daniel I. ;
Lachmann, Burkhard ;
Kacmarek, Robert M. ;
Slutsky, Arthur S. ;
De Baerdemaeker, Luc ;
De Hert, Stefan ;
Heyse, Bjorn ;
Van Limmen, Jurgen ;
Mulier, Jan-Paul ;
Velghe, David ;
Jamaer, Luc ;
Vandenbrande, Jeroen ;
Bugedo, Guillermo ;
Florez, Jorge ;
Goranovic, Tatjana ;
Mazul-Sunko, Branka ;
Bluth, Thomas ;
Guldner, Andreas ;
Kiss, Thomas ;
Koch, Thea ;
Spieth, Peter Markus ;
Uhlig, Christopher ;
Yaqub, Jonathan ;
Bastin, Bea ;
Geib, Johann ;
Schaefer, Maximilian S. ;
Weiss, Martin ;
Treschan, Tanja A. ;
Reske, Andreas W. ;
Simon, Philipp ;
Ferner, Alexander Brodhun Marion ;
Hartmann, Eric ;
Laufenberg-Feldmann, Rita ;
Strys, Lydia ;
De Robertis, Edoardo ;
Perilli, Valter .
LANCET, 2014, 384 (9942) :495-503
[29]   Performance characteristics of five new anesthesia ventilators and four intensive care ventilators in pressure-support mode - A comparative bench study [J].
Jaber, Samir ;
Tassaux, Didier ;
Sebbane, Mustapha ;
Pouzeratte, Yvan ;
Battisti, Anne ;
Capdevila, Xavier ;
Eledjam, Jean-Jacques ;
Jolliet, Philippe .
ANESTHESIOLOGY, 2006, 105 (05) :944-952
[30]   Comparison of volume-controlled and pressure-controlled ventilation using a laryngeal mask airway during gynecological laparoscopy [J].
Jeon, Woo Jae ;
Cho, Sang Yun ;
Bang, Mi Rang ;
Ko, So-Young .
KOREAN JOURNAL OF ANESTHESIOLOGY, 2011, 60 (03) :167-172