Effects of 12 and 17 cmH2O positive end-expiratory pressure applied after alveolar recruitment maneuver on pulmonary gas exchange and compliance in isoflurane-anesthetized horses.
Abstract: To compare static compliance (C) and alveolar-arterial oxygen tension difference [P(a-a)O] between positive end-expiratory pressures (PEEP) of 7, 12 and 17 cmHO applied after an alveolar recruitment maneuver (RM) in isoflurane-anesthetized horses. Methods: Prospective, randomized, clinical study. Methods: A group of 30 healthy adult horses undergoing arthroscopic surgery. Methods: Animals in dorsal recumbency and mechanically ventilated with a tidal volume of 14 mL kg and 7 cmHO PEEP (control; n = 6) were subjected to an RM by increasing PEEP from 7 to 22 cmHO in 5 cmHO increments at 5 minute intervals, and then decreased similarly to PEEP of 17 (RM17; n = 8), 12 (RM12; n = 8) or 7 cmHO (RM7; n = 8). C and P(a-a)O were assessed prior to (baseline) and after the RM at 5, 10, 15, 20, 40, 60 and 80 minutes after achieving each target PEEP, and during recovery from anesthesia. Results: Post-RM improvements on P(a-a)O were maintained (baseline versus 80 minutes) in RM12 [216 ± 77 mmHg (28.8 ± 10.3 kPa) versus 194 ± 39 mmHg (25.9 ± 5.2 kPa)] and RM17 [180 ± 86 mmHg (24.0 ± 11.6 kPa) versus 136 ± 75 mmHg [18.2 ± 10.0 kPa]). The improvements on C were maintained only in RM12 (0.80 ± 0.13 versus 0.98 ± 0.13 mL cmHO kg). No such improvements were observed in RM7 and control. No significant differences were observed between groups during recovery from anesthesia. Conclusions: and clinical relevance The 12 and 17 cmHO PEEP can be used to maintain the improvements on P(a-a)O obtained after an RM. Only 12 cmHO PEEP maintained the post-RM increase on C. Such variables were not influenced by the 7 cmHO PEEP.
Copyright © 2018 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.
Publication Date: 2018-09-07 PubMed ID: 30361113DOI: 10.1016/j.vaa.2018.08.003Google Scholar: Lookup
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- Clinical Trial
- Veterinary
- Journal Article
Summary
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The study investigates the effects of different positive end-expiratory pressures (PEEP) applied after an alveolar recruitment maneuver (RM) on oxygen tension difference and lung compliance in anesthetized horses. The results indicated that only a PEEP of 12 cmH2O was able to maintain improvements on both parameters after an RM.
Background
- The study focuses on understanding the impacts of different levels of positive end-expiratory pressure (PEEP) – 7, 12, and 17 cmH2O, deployed post an alveolar recruitment maneuver (RM) in horses undergoing anesthesia.
- This research was motivated by the objective to find out how different PEEP post RM could influence the static compliance (a measure of the ability of a hollow organ to distend and increase volume with increasing transliminal pressure or gradually decreasing pressure) and alveolar-arterial oxygen tension difference (a measure of gas exchange across the lung).
Methodology
- A prospective, randomized, clinical study was conducted with a group of 30 healthy adult horses undergoing arthroscopic surgery.
- The horses were in dorsal recumbency and mechanically ventilated, and were exposed to an RM by systematically increasing and decreasing the PEEP levels.
- The parameters – static compliance (C) and alveolar-arterial oxygen tension difference (P(a-a)O) – were assessed before (baseline) as well as after RM at set intervals and during recovery from anesthesia.
Findings
- Post RM, substantial improvements were observed in P(a-a)O in horses where PEEP of 12 (RM12) and 17 (RM17) cmH2O was used.
- However, enhancements in lung compliance were only sustained in horses with a PEEP of 12 cmH2O (RM12).
- Neither the PEEP of 7 cmHO (RM7) nor the control group showed these improvements.
- No significant differences were observed between the groups during recovery from anesthesia.
Conclusions and Clinical Relevance
- Both 12 and 17 cmHO PEEP effectively maintained the improvements in P(a-a)O achieved after an RM.
- However, only a PEEP of 12 cmHO was able to maintain the enhancement in lung compliance post-RM.
- The observations from this study inferred that the 7 cmHO PEEP, on the other hand, did not influence these variables of interest.
Cite This Article
APA
Andrade FS, Facó LL, Ida KK, Silva LC, Fantoni DT, Ambrósio AM.
(2018).
Effects of 12 and 17 cmH2O positive end-expiratory pressure applied after alveolar recruitment maneuver on pulmonary gas exchange and compliance in isoflurane-anesthetized horses.
Vet Anaesth Analg, 46(1), 64-73.
https://doi.org/10.1016/j.vaa.2018.08.003 Publication
Researcher Affiliations
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, SP, Brazil. Electronic address: fesandrade@usp.br.
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, SP, Brazil.
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, SP, Brazil.
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, SP, Brazil.
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, SP, Brazil.
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, SP, Brazil.
MeSH Terms
- Anesthesia / veterinary
- Anesthetics, Inhalation / administration & dosage
- Anesthetics, Inhalation / pharmacology
- Animals
- Arthroscopy / veterinary
- Blood Gas Analysis / veterinary
- Female
- Horses / physiology
- Isoflurane / administration & dosage
- Isoflurane / pharmacology
- Male
- Positive-Pressure Respiration / veterinary
- Prospective Studies
- Pulmonary Alveoli / drug effects
- Random Allocation
- Tidal Volume / drug effects
- Treatment Outcome
Citations
This article has been cited 4 times.- Andrade FSRM, Ambrósio AM, Rodrigues RR, Faccó LL, Gonçalves LA, Garcia Filho SG, Dos Santos RT, Rossetto TC, Pereira MAA, Fantoni DT. The optimal PEEP after alveolar recruitment maneuver assessed by electrical impedance tomography in healthy horses. Front Vet Sci 2022;9:1024088.
- Gozalo-Marcilla M, Ringer SK. Recovery after General Anaesthesia in Adult Horses: A Structured Summary of the Literature. Animals (Basel) 2021 Jun 14;11(6).
- Bukoski A, Downs J, Hodgson DS, Le-Bert CR, Thomen R, Flors L, Thombs L, Bailey J. Cardiopulmonary effects of apneustic anesthesia ventilation in anesthetized pigs: a new mode of ventilation for anesthetized veterinary species. Front Vet Sci 2024;11:1378617.
- Ambrósio AM, Fantoni DT. Editorial: Mechanical ventilation in anesthesia and critical care animal patients, volume II. Front Vet Sci 2024;11:1402629.
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