Effects of positive end-expiratory pressure titration on gas exchange, respiratory mechanics and hemodynamics in anesthetized horses.
Abstract: To assess if positive end-expiratory pressure (PEEP) titration improves gas exchange and respiratory mechanics, without hemodynamic impairment in horses during anesthesia. Methods: Prospective, randomized study. Methods: Thirteen isoflurane-anesthetized healthy horses. Methods: After 60 minutes of anesthesia with spontaneous breathing, mechanical ventilation was initiated with an inspiratory-expiratory ratio of 1:2, PEEP of 5 cmH2O, tidal volume of 10-20 mL kg(-1) and respiratory rate adjusted to maintain normocapnia. Constant PEEP of 5 cmH2O was continued (control group; n = 6) or titrated (PEEP group; n = 7) by increasing and decreasing PEEP from 5 to 20 cmH2O at 15-minute intervals. The horses were instrumented with an arterial catheter to measure blood pressure and allow collection of blood for pH and blood gas analysis and a Swan-Ganz catheter for measurement of cardiac output (CO) using thermodilution. Cardiopulmonary assessment was recorded before PEEP titration and after 15 minutes at each PEEP value. Results: In the PEEP group, static compliance (range) (Cst 278-463 mL cmH2O(-1)) was significantly higher and the shunt fraction (Q·s/Q·t 7-20%) and the alveolar-arterial oxygen difference [P(A-a)O2 95-325 mmHg] were significantly lower than in the control group [Cst of 246-290 mL cmH2O(-1), Q·s/Q·t of 16-19%, P(A-a)O2 of 253-310 mmHg; p < 0.05]. CO (mean ± SEM) was lower in the PEEP group (23 ± 2 L minute(-1)) at 20 cmH2O PEEP than in the control group (26 ± 4 L minute(-1), p < 0.05), with no significant changes in heart rate, blood pressure or central venous pressure. Conclusions: PEEP titration significantly improved gas exchange and lung compliance, with a small decrease in CO at the highest PEEP level. Conclusions: Gas exchange and respiratory mechanics impairment during inhalation anesthesia can be treated using PEEP titration from 5 to 20 cmH2O, without clinically important hemodynamic effects in healthy horses.
© 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.
Publication Date: 2013-07-15 PubMed ID: 23848843DOI: 10.1111/vaa.12068Google Scholar: Lookup
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- Journal Article
- Research Support
- Non-U.S. Gov't
Summary
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The research investigates the impact of increasing positive end-expiratory pressure (PEEP) on gas exchange and respiratory mechanics in anaesthetized horses, and finds it can lead to improved conditions without significantly affecting the horses’ hemodynamics.
Methodology
- The study was a prospective and randomized one, involving thirteen horses that were healthy and anesthetized with isoflurane.
- After 60 minutes of anesthesia during which the horses breathed spontaneously, mechanical ventilation commenced with a set inspiratory-expiratory ratio, PEEP, tidal volume and respiratory rate.
- The study divided the horses into two groups: the control group maintained a constant PEEP of 5 cmH2O, while the PEEP group underwent changes with the PEEP increasing and decreasing between 5 to 20 cmH2O every 15 minutes.
- The horses were fitted with arterial and Swan-Ganz catheters to measure blood parameters and cardiac output, respectively. Evaluations were made before PEEP changes and after each 15-minute PEEP interval.
Results
- The PEEP group exhibited significantly higher lung compliance and significantly lower shunt fractions and alveolar-arterial oxygen differences compared to the control group.
- The cardiac output at the highest PEEP level was lower in the PEEP group compared to the control group. However, there was no significant change in heart rate, blood pressure, or central venous pressure.
Conclusions
- The results show that PEEP titration can significantly improve gas exchange and lung compliance.
- While the cardiac output was a bit lower at the highest PEEP level in the PEEP group, the study suggests that this change is not clinically significant.
- The study concludes that impairments in gas exchange and respiratory mechanics during inhalation anesthesia can be mitigated using PEEP titration from 5 to 20 cmH2O, without causing substantial hemodynamic effects in healthy horses.
Cite This Article
APA
Ambrósio AM, Ida KK, Souto MT, Oshiro AH, Fantoni DT.
(2013).
Effects of positive end-expiratory pressure titration on gas exchange, respiratory mechanics and hemodynamics in anesthetized horses.
Vet Anaesth Analg, 40(6), 564-572.
https://doi.org/10.1111/vaa.12068 Publication
Researcher Affiliations
- Department of Surgery, Faculty of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil.
MeSH Terms
- Anesthesia, General / methods
- Anesthesia, General / veterinary
- Animals
- Blood Gas Analysis / veterinary
- Blood Pressure / physiology
- Cardiac Output / physiology
- Hemodynamics
- Horses / physiology
- Horses / surgery
- Positive-Pressure Respiration / methods
- Positive-Pressure Respiration / veterinary
- Pulmonary Gas Exchange / physiology
- Respiratory Mechanics / physiology
- Respiratory Rate / physiology
Citations
This article has been cited 9 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.
- Rodrigues RR, Ambrósio AM, Engbruch AM, Gonçalves LA, Villela PA, Sanchez AF, Fantoni DT. Intraoperative Protective Mechanical Ventilation in Dogs: A Randomized Clinical Trial. Front Vet Sci 2022;9:842613.
- Ambrósio AM, Sanchez AF, Pereira MAA, Andrade FSRM, Rodrigues RR, Vitorasso RL, Moriya HT, Fantoni DT. Assessment of Regional Ventilation During Recruitment Maneuver by Electrical Impedance Tomography in Dogs. Front Vet Sci 2021;8:815048.
- Stefanik E, Drewnowska O, Lisowska B, Turek B. Causes, Effects and Methods of Monitoring Gas Exchange Disturbances during Equine General Anaesthesia. Animals (Basel) 2021 Jul 9;11(7).
- Algera AG, Pisani L, Chaves RCF, Amorim TC, Cherpanath T, Determann R, Dongelmans DA, Paulus F, Tuinman PR, Pelosi P, Gama de Abreu M, Schultz MJ, Serpa Neto A. Effects of peep on lung injury, pulmonary function, systemic circulation and mortality in animals with uninjured lungs-a systematic review. Ann Transl Med 2018 Jan;6(2):25.
- Yang M, Deng Z, He X, Guo J, Yang S, Cheng Q. Jet ventilation dynamics in rigid bronchoscope: insights from a simulated experimental model. BMC Anesthesiol 2025 Jul 2;25(1):332.
- Brito PHS, Ferreira MA, Rusch E, Arantes JA, Carregaro AB, Valadão CAA, Ghantous GF, Dória RGS. Anesthesia for non-obstetric surgery during late term pregnancy in mares. PLoS One 2024;19(11):e0313563.
- 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.
- Leung J, Beths T, Lynch M, Frith S, Bauquier SH. A simple method to provide positive end expiratory pressure to treat hypoxaemia in an anaesthetised Asian Elephant (Elephas maximus). J S Afr Vet Assoc 2021 May 19;92(0):e1-e4.
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