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- Author or Editor: Carmelinda De Marzo x
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Abstract
Objective—To evaluate the effectiveness of reduction of inspired oxygen fraction (Fio 2) or application of positive end-expiratory pressure (PEEP) after an alveolar recruitment maneuver (ARM) in minimizing anesthesia-induced atelectasis in dogs.
Animals—30 healthy female dogs.
Procedures—During anesthesia and neuromuscular blockade, dogs were mechanically ventilated under baseline conditions (tidal volume, 12 mL/kg; inspiratory-to-expiratory ratio, 1:2; Fio 2, 1; and zero end-expiratory pressure [ZEEP]). After 40 minutes, lungs were inflated (airway pressure, 40 cm H2O) for 20 seconds. Dogs were then exposed to baseline conditions (ZEEP100 group), baseline conditions with Fio 2 reduced to 0.4 (ZEEP40 group), or baseline conditions with PEEP at 5 cm H2O (PEEP100 group; 10 dogs/group). For each dog, arterial blood gas variables and respiratory system mechanics were evaluated and CT scans of the thorax were obtained before and at 5 (T5) and 30 (T30) minutes after the ARM.
Results—Compared with pre-ARM findings, atelectasis decreased and Pao 2:Fio 2 ratio increased at T5 in all groups. At T30, atelectasis and oxygenation returned to pre-ARM findings in the ZEEP100 group but remained similar to T5 findings in the other groups. At T5 and T30, lung static compliance in the PEEP100 group was higher than values in the other groups.
Conclusions and Clinical Relevance—Application of airway pressure of 40 cm H2O for 20 seconds followed by Fio 2 reduction to 0.4 or ventilation with PEEP (5 cm H2O) was effective in diminishing anesthesia-induced atelectasis and maintaining lung function in dogs, compared with the effects of mechanical ventilation providing an Fio 2 of 1.
Abstract
Objective—To evaluate the use of the oxygen content–based index, Fshunt, as an indicator of venous admixture (
s/t) at various fractions of inspired oxygen (Fio
2s) in anesthetized sheep undergoing Flung or 2-lung ventilation.
Animals—6 healthy adult female sheep.
Procedures—Sheep were anesthetized and administered 5 different Fio
2s (0.21, 0.40, 0.60, 0.80, and 1.00) in random order during 2-lung mechanical ventilation. Arterial and mixed venous blood samples were obtained at each Fio
2 after a 15-minute stabilization period. Vital capacity alveolar recruitment maneuvers were performed after blood collection. The previously used Fio
2 sequence was reversed for sample collection during Flung ventilation. Blood samples were analyzed for arterial, pulmonary end-capillary, and mixed venous oxygen content and partial pressure and for hemoglobin concentration. Oxygen hemoglobin saturation, s/t, Fshunt, and oxygen tension–based indices (OTIs; including Pao
2:Fio
2, alveolar-arterial difference in partial pressure of oxygen [Pao
2 – Pao
2], [Pao
2 – Pao
2]:Fio
2, [Pao
2 – Pao
2]:Pao
2, and Pao
2:Pao
2) were calculated at each Fio
2; associations were evaluated with linear regression analysis, concordance, and correlation tests. Intermethod agreement between s/t and Fshunt was tested via Bland-Altman analysis.
Results—Strong and significant associations and substantial agreement were detected between Fshunt and s/t. Relationships between OTIs and s/t varied, but overall correlations were weak.
Conclusions and Clinical Relevance—Whereas OTIs were generally poor indicators of s/t, Fshunt was a good indicator of s/t at various Fio
2s, regardless of the magnitude of s/t, and could be potentially used as a surrogate for s/t measurements in healthy sheep.
