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
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- 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
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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.
References
This article includes 31 references
- Nyman G, Hedenstierna G. Ventilation-perfusion relationships in the anaesthetised horse.. Equine Vet J 1989 Jul;21(4):274-81.
- Ambrósio AM, Ida KK, Souto MT, Oshiro AH, Fantoni DT. Effects of positive end-expiratory pressure titration on gas exchange, respiratory mechanics and hemodynamics in anesthetized horses.. Vet Anaesth Analg 2013 Nov;40(6):564-72.
- Andrade FS, Facó LL, Ida KK, Silva LC, Fantoni DT, Ambrósio AM. Effects of 12 and 17 cmH(2)O positive end-expiratory pressure applied after alveolar recruitment maneuver on pulmonary gas exchange and compliance in isoflurane-anesthetized horses.. Vet Anaesth Analg 2019 Jan;46(1):64-73.
- Wettstein D, Moens Y, Jaeggin-Schmucker N, Böhm SH, Rothen HU, Mosing M, Kästner SB, Schatzmann U. Effects of an alveolar recruitment maneuver on cardiovascular and respiratory parameters during total intravenous anesthesia in ponies.. Am J Vet Res 2006 Jan;67(1):152-9.
- Hopster K, Kästner SB, Rohn K, Ohnesorge B. Intermittent positive pressure ventilation with constant positive end-expiratory pressure and alveolar recruitment manoeuvre during inhalation anaesthesia in horses undergoing surgery for colic, and its influence on the early recovery period.. Vet Anaesth Analg 2011 May;38(3):169-77.
- Martins ARC, Ambrósio AM, Fantoni DT, Pinto ACBCF, Villamizar-Martinez LA, Soares JHN, Otsuki DA, Malbouisson LMS. Computed Tomography Assessment of Tidal Lung Overinflation in Domestic Cats Undergoing Pressure-Controlled Mechanical Ventilation During General Anesthesia.. Front Vet Sci 2022;9:842528.
- Staffieri F, Franchini D, Carella GL, Montanaro MG, Valentini V, Driessen B, Grasso S, Crovace A. Computed tomographic analysis of the effects of two inspired oxygen concentrations on pulmonary aeration in anesthetized and mechanically ventilated dogs.. Am J Vet Res 2007 Sep;68(9):925-31.
- Mosing M, Auer U, MacFarlane P, Bardell D, Schramel JP, Böhm SH, Bettschart-Wolfensberger R, Waldmann AD. Regional ventilation distribution and dead space in anaesthetized horses treated with and without continuous positive airway pressure: novel insights by electrical impedance tomography and volumetric capnography.. Vet Anaesth Analg 2018 Jan;45(1):31-40.
- Mosing M, Marly-Voquer C, MacFarlane P, Bardell D, Böhm SH, Bettschart-Wolfensberger R, Waldmann AD. Regional distribution of ventilation in horses in dorsal recumbency during spontaneous and mechanical ventilation assessed by electrical impedance tomography: a case series.. Vet Anaesth Analg 2017 Jan;44(1):127-132.
- Ambrisko TD, Schramel J, Hopster K, Kästner S, Moens Y. Assessment of distribution of ventilation and regional lung compliance by electrical impedance tomography in anaesthetized horses undergoing alveolar recruitment manoeuvres.. Vet Anaesth Analg 2017 Mar;44(2):264-272.
- Moens Y, Schramel JP, Tusman G, Ambrisko TD, Solà J, Brunner JX, Kowalczyk L, Böhm SH. Variety of non-invasive continuous monitoring methodologies including electrical impedance tomography provides novel insights into the physiology of lung collapse and recruitment – case report of an anaesthetized horse.. Vet Anaesth Analg 2014 Mar;41(2):196-204.
- 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.
- Ambrosio AM, Carvalho-Kamakura TPA, Ida KK, Varela B, Andrade FSRM, Facó LL, Fantoni DT. Ventilation distribution assessed with electrical impedance tomography and the influence of tidal volume, recruitment and positive end-expiratory pressure in isoflurane-anesthetized dogs.. Vet Anaesth Analg 2017 Mar;44(2):254-263.
- Mosing M, Waldmann AD, Raisis A, Böhm SH, Drynan E, Wilson K. Monitoring of tidal ventilation by electrical impedance tomography in anaesthetised horses.. Equine Vet J 2019 Mar;51(2):222-226.
- Ambrisko TD, Schramel JP, Adler A, Kutasi O, Makra Z, Moens YP. Assessment of distribution of ventilation by electrical impedance tomography in standing horses.. Physiol Meas 2016 Feb;37(2):175-86.
- Beazley SG, Focken A, Fernandez-Parra R, Thomas KL, Adler A, Duke-Novakovski T. Evaluation of lung ventilation distribution using electrical impedance tomography in standing sedated horses with capnoperitoneum.. Vet Anaesth Analg 2022 Jul;49(4):382-389.
- Brabant OA, Byrne DP, Sacks M, Moreno Martinez F, Raisis AL, Araos JB, Waldmann AD, Schramel JP, Ambrosio A, Hosgood G, Braun C, Auer U, Bleul U, Herteman N, Secombe CJ, Schoster A, Soares J, Beazley S, Meira C, Adler A, Mosing M. Thoracic Electrical Impedance Tomography-The 2022 Veterinary Consensus Statement.. Front Vet Sci 2022;9:946911.
- Fumagalli J, Santiago RRS, Teggia Droghi M, Zhang C, Fintelmann FJ, Troschel FM, Morais CCA, Amato MBP, Kacmarek RM, Berra L. Lung Recruitment in Obese Patients with Acute Respiratory Distress Syndrome.. Anesthesiology 2019 May;130(5):791-803.
- Ukere A, März A, Wodack KH, Trepte CJ, Haese A, Waldmann AD, Böhm SH, Reuter DA. Perioperative assessment of regional ventilation during changing body positions and ventilation conditions by electrical impedance tomography.. Br J Anaesth 2016 Aug;117(2):228-35.
- Zambon M, Greco M, Bocchino S, Cabrini L, Beccaria PF, Zangrillo A. Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review.. Intensive Care Med 2017 Jan;43(1):29-38.
- Spadaro S, Mauri T, Böhm SH, Scaramuzzo G, Turrini C, Waldmann AD, Ragazzi R, Pesenti A, Volta CA. Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitment.. Crit Care 2018 Jan 31;22(1):26.
- Kudnig ST, Monnet E, Riquelme M, Gaynor JS, Corliss D, Salman MD. Effect of positive end-expiratory pressure on oxygen delivery during 1-lung ventilation for thoracoscopy in normal dogs.. Vet Surg 2006 Aug;35(6):534-42.
- Briganti A, Portela DA, Grasso S, Sgorbini M, Tayari H, Bassini JR, Vitale V, Romano MS, Crovace A, Breghi G, Staffieri F. Accuracy of different oxygenation indices in estimating intrapulmonary shunting at increasing infusion rates of dobutamine in horses under general anaesthesia.. Vet J 2015 Jun;204(3):351-6.
- Karalapillai D, Weinberg L, Peyton P, Ellard L, Hu R, Pearce B, Tan CO, Story D, O'Donnell M, Hamilton P, Oughton C, Galtieri J, Wilson A, Serpa Neto A, Eastwood G, Bellomo R, Jones DA. Effect of Intraoperative Low Tidal Volume vs Conventional Tidal Volume on Postoperative Pulmonary Complications in Patients Undergoing Major Surgery: A Randomized Clinical Trial.. JAMA 2020 Sep 1;324(9):848-858.
- Tusman G, Böhm SH. Prevention and reversal of lung collapse during the intra-operative period.. Best Pract Res Clin Anaesthesiol 2010 Jun;24(2):183-97.
- Lachmann B. Open up the lung and keep the lung open.. Intensive Care Med 1992;18(6):319-21.
- Hopster K, Jacobson B, Hopster-Iversen C, Rohn K, Kästner SBR. Histopathological changes and mRNA expression in lungs of horses after inhalation anaesthesia with different ventilation strategies.. Res Vet Sci 2016 Aug;107:8-15.
- Hopster K, Rohn K, Ohnesorge B, Kästner SBR. Controlled mechanical ventilation with constant positive end-expiratory pressure and alveolar recruitment manoeuvres during anaesthesia in laterally or dorsally recumbent horses.. Vet Anaesth Analg 2017 Jan;44(1):121-126.
- Nielsen J, Nilsson M, Fredén F, Hultman J, Alström U, Kjaergaard J, Hedenstierna G, Larsson A. Central hemodynamics during lung recruitment maneuvers at hypovolemia, normovolemia and hypervolemia. A study by echocardiography and continuous pulmonary artery flow measurements in lung-injured pigs.. Intensive Care Med 2006 Apr;32(4):585-94.
- Canfrán S, Gómez de Segura IA, Cediel R, García-Fernández J. Effects of a stepwise lung recruitment manoeuvre and positive end-expiratory pressure on lung compliance and arterial blood oxygenation in healthy dogs.. Vet J 2012 Oct;194(1):89-93.
- Grychtol B, Schramel JP, Braun F, Riedel T, Auer U, Mosing M, Braun C, Waldmann AD, Böhm SH, Adler A. Thoracic EIT in 3D: experiences and recommendations.. Physiol Meas 2019 Aug 2;40(7):074006.
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