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The optimal PEEP after alveolar recruitment maneuver assessed by electrical impedance tomography in healthy horses.
Abstract: Electrical impedance tomography (EIT) has been an essential tool for assessing pulmonary ventilation in several situations, such as the alveolar recruitment maneuver (ARM) in PEEP titration to maintain the lungs open after atelectasis reversion. In the same way as in humans and dogs, in horses, this tool has been widely used to assess pulmonary aeration undergoing anesthesia, mechanical ventilation, recruitment maneuver, standing horses, or specific procedures. Unassigned: The present study aimed to evaluate the distribution of regional ventilation during ARM based on lung monitoring assessment by EIT, with a focus on better recruitment associated with less or no overdistention. Unassigned: Fourteen horses of 306 ± 21 kg undergoing isoflurane anesthesia in dorsal recumbency were used. The animals were mechanically ventilated with a tidal volume of 14 ml kg and a respiratory rate of 7-9. An alveolar recruitment maneuver was instituted, increasing the PEEP by five cmHO every 5 min until 32 cmHO and decreasing it by five cmHO every 5 min to 7 cmHO. At each step of PEEP, arterial blood samples were collected for blood gas analysis, EIT images, hemodynamic, and respiratory mechanics. Unassigned: Associated with the CoV-DV increase, there was a significant decrease in the DSS during the ARM and a significant increase in the NSS when PEEP was applied above 12 cmHO compared to baseline. The Compl showed a significant increase in the dependent area and a significant decrease in the non-dependent area during ARM, and both were compared to their baseline values. The driving pressure decreased significantly during the ARM, and Cst, PaO, and PaO/FiO ratio increased significantly. The V/V decreased significantly at DEPEEP17 and DEPEEP12. There was an HR increase at INPEEP27, INPEEP 32, and DEPEEP17 ( < 0.0001; < 0.0001; and < 0.05, respectively), those values being above the normal reference range for the species. The SAP, MAP, DAP, CI, and DOI significantly decreased INPEEP32 ( < 0.05). Unassigned: The ARM by PEEP titration applied in the present study showed better ventilation distribution associated with better aeration in the dependent lung areas, with minimal overdistention between PEEP 17 and 12 cmHO decreasing step. Those changes were also followed by improvements in static and regional compliance associated with increased oxygenation and pulmonary ventilation. ARM promoted a transitory decrease in arterial blood pressure and depression in CI with a concomitant drop in oxygen delivery, which should be best investigated before its routine use in clinical cases.
Copyright © 2022 Andrade, Ambrósio, Rodrigues, Faccó, Gonçalves, Garcia Filho, dos Santos, Rossetto, Pereira and Fantoni.
Publication Date: 2022-12-09 PubMed ID: 36570501PubMed Central: PMC9780380DOI: 10.3389/fvets.2022.1024088Google Scholar: Lookup The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Journal Article
- Anesthesia
- Clinical Examination
- Clinical Study
- Clinical Symptoms
- Diagnosis
- Diagnostic Technique
- Disease Diagnosis
- Disease Treatment
- Equine Health
- Hemodynamics
- Horses
- Imaging Techniques
- In Vivo
- Lung Health
- Physiology
- Pulmonary Health
- Respiratory Health
- Surgery
- Veterinary Medicine
- Veterinary Procedure
- Veterinary Research
Summary
This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.
The research paper explores the use of Electrical Impedance Tomography (EIT) to assess the best possible Positive End-Expiratory Pressure (PEEP) after an alveolar recruitment maneuver (ARM) in healthy horses undergoing anaesthesia. The study suggests that better ventilation distribution, minimal overdistention, and improved oxygenation occur between a PEEP of 17 and 12 cmHO.
Objective and Methodology
- The objective of the research was to understand the distribution of ventilation during an ARM, using EIT for assessment, with a goal to find the optimal recruitment with no or minimal overdistention.
- The study was conducted on fourteen horses each weighing around 306 ± 21 kg. These horses were anesthetized and mechanically ventilated.
- The ARM process was implemented, which involved increasing and decreasing the PEEP. The PEEP was increased by five cmHO every five minutes until it reached 32 cmHO, and then decreased by a similar amount down to 7 cmHO.
- Arterial blood samples were drawn at each step of PEEP for blood gas analysis. Equally, EIT images were captured, and hemodynamic and respiratory mechanics were recorded.
Findings
- The study found that with increased CoV-DV, there was a notable decrease in the DSS during the ARM. Conversely, there was a significant rise in the NSS when PEEP was applied above 12 cmHO.
- There was an apparent increase in the dependent area’s compliance and a notable decrease in the non-dependent area during ARM.
- The driving pressure significantly decreased during the ARM, while Cst, PaO, and PaO/FiO ratio increased markedly.
- V/V significantly dropped at DEPEEP17 and DEPEEP12, with heart rate (HR) increasing at INPEEP27, INPEEP 32, and DEPEEP17. These values were above the standard range for the species.
- SAP, MAP, DAP, CI, and DOI declined significantly at INPEEP32.
Conclusions
- ARM through PEEP titration showed improved ventilation distribution and better aeration of the dependent lung areas, with minimal overdistention occurring between a PEEP of 17 and 12 cmHO.
- Changes were also monitored in static and regional compliance – both improved – along with increased oxygenation and pulmonary ventilation.
- However, the ARM also led to a temporary decrease in arterial blood pressure and a drop in cardiac index, which subsequently resulted in reduced oxygen delivery. It has been suggested that further research is required before ARMs are regularly used in clinical cases.
Cite This Article
APA
Andrade FSRM, Ambrósio AM, Rodrigues RR, Faccó LL, Gonçalves LA, Garcia Filho SG, Dos Santos RT, Rossetto TC, Pereira MAA, Fantoni DT.
(2022).
The optimal PEEP after alveolar recruitment maneuver assessed by electrical impedance tomography in healthy horses.
Front Vet Sci, 9, 1024088.
https://doi.org/10.3389/fvets.2022.1024088 Publication
Researcher Affiliations
- 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.
- 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.
Conflict of Interest Statement
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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