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Impact of Different Ventilation Strategies on Driving Pressure, Mechanical Power, and Biological Markers During Open Abdominal Surgery in Rats
- Source :
- Anesthesia and analgesia, 125(4), 1364-1374. Lippincott Williams and Wilkins
- Publication Year :
- 2017
-
Abstract
- Intraoperative mechanical ventilation may yield lung injury. To date, there is no consensus regarding the best ventilator strategy for abdominal surgery. We aimed to investigate the impact of the mechanical ventilation strategies used in 2 recent trials (Intraoperative Protective Ventilation [IMPROVE] trial and Protective Ventilation using High versus Low PEEP [PROVHILO] trial) on driving pressure (ΔPRS), mechanical power, and lung damage in a model of open abdominal surgery. Thirty-five Wistar rats were used, of which 28 were anesthetized, and a laparotomy was performed with standardized bowel manipulation. Postoperatively, animals (n = 7/group) were randomly assigned to 4 hours of ventilation with: (1) tidal volume (VT) = 7 mL/kg and positive end-expiratory pressure (PEEP) = 1 cm H2O without recruitment maneuvers (RMs) (low VT/low PEEP/RM-), mimicking the low-VT/low-PEEP strategy of PROVHILO; (2) VT = 7 mL/kg and PEEP = 3 cm H2O with RMs before laparotomy and hourly thereafter (low VT/moderate PEEP/4 RM+), mimicking the protective ventilation strategy of IMPROVE; (3) VT = 7 mL/kg and PEEP = 6 cm H2O with RMs only before laparotomy (low VT/high PEEP/1 RM+), mimicking the strategy used after intubation and before extubation in PROVHILO; or (4) VT = 14 mL/kg and PEEP = 1 cm H2O without RMs (high VT/low PEEP/RM-), mimicking conventional ventilation used in IMPROVE. Seven rats were not tracheotomized, operated, or mechanically ventilated, and constituted the healthy nonoperated and nonventilated controls. Low VT/moderate PEEP/4 RM+ and low VT/high PEEP/1 RM+, compared to low VT/low PEEP/RM- and high VT/low PEEP/RM-, resulted in lower ΔPRS (7.1 ± 0.8 and 10.2 ± 2.1 cm H2O vs 13.9 ± 0.9 and 16.9 ± 0.8 cm H2O, respectively; P
- Subjects :
- Abdomen
Animals
Biomarkers
Laparotomy
Positive-Pressure Respiration
Random Allocation
Rats
Rats, Wistar
Respiration, Artificial
Respiratory Mechanics
Anesthesiology and Pain Medicine
medicine.medical_treatment
Wistar
Lung injury
law.invention
03 medical and health sciences
0302 clinical medicine
030202 anesthesiology
law
Medicine
Mechanical ventilation
business.industry
Respiration
030208 emergency & critical care medicine
respiratory system
respiratory tract diseases
Anesthesia
Artificial
Ventilation (architecture)
business
circulatory and respiratory physiology
Abdominal surgery
Subjects
Details
- ISSN :
- 15267598 and 00032999
- Volume :
- 125
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Anesthesia and analgesia
- Accession number :
- edsair.doi.dedup.....d6f48a169e5ede9e71380683b23fc21b