Trial reportAnesthesia and analgesia2018
Respiratory System Mechanics During Low Versus High Positive End-Expiratory Pressure in Open Abdominal Surgery: A Substudy of PROVHILO Randomized Controlled Trial.
Trial report in Anesthesia and analgesia, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 29 citations in OpenAlex.
- Perioperative Open-lung Approach, Regional Ventilation, and Lung Injury in Cardiac Surgery.Anesthesiology · 2020Trial
- Effect of open-lung vs conventional perioperative ventilation strategies on postoperative pulmonary complications after on-pump cardiac surgery: the PROVECS randomized clinical trial.Intensive care medicine · 2019Trial
- Atelectrauma can be avoided if expiration is sufficiently brief: evidence from inverse modeling and oscillometry during airway pressure release ventilation.Critical care (London, England) · 2024Article
- Positive End-Expiratory Pressure in Rhinoplasty Surgery; Risks and Benefits.Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India · 2023Article
- Effect of individualized PEEP titration by ultrasonography on perioperative pulmonary protection and postoperative cognitive function in patients with chronic obstructive pulmonary disease.BMC pulmonary medicine · 2023Article
- Non-invasive over-distension measurements: data driven vs model-based.Journal of clinical monitoring and computing · 2023Article
- Individualized positive end-expiratory pressure titration on respiration and circulation in elderly patients undergoing spinal surgery in prone position under general anesthesia.American journal of translational research · 2021Article
- Imaging the Injured Lung: Mechanisms of Action and Clinical Use.Anesthesiology · 2019Review
- Should we titrate ventilation based on driving pressure? Maybe not in the way we would expect.Annals of translational medicine · 2018Review
- Respiratory mechanics during general anaesthesia.Annals of translational medicine · 2018Review
- Article
- Intratidal Analysis of Intraoperative Respiratory System Mechanics: Keep it Simple.Anesthesia and analgesia · 2018Article
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15 authors at 8 institutions in 4 countries.
Funding
Abstract
backgroundIn the 2014 PROtective Ventilation using HIgh versus LOw positive end-expiratory pressure (PROVHILO) trial, intraoperative low tidal volume ventilation with high positive end-expiratory pressure (PEEP = 12 cm H2O) and lung recruitment maneuvers did not decrease postoperative pulmonary complications when compared to low PEEP (0-2 cm H2O) approach without recruitment breaths. However, effects of intraoperative PEEP on lung compliance remain poorly understood. We hypothesized that higher PEEP leads to a dominance of intratidal overdistension, whereas lower PEEP results in intratidal recruitment/derecruitment (R/D). To test our hypothesis, we used the volume-dependent elastance index %E2, a respiratory parameter that allows for noninvasive and radiation-free assessment of dominant overdistension and intratidal R/D. We compared the incidence of intratidal R/D, linear expansion, and overdistension by means of %E2 in a subset of the PROVHILO cohort.
methodsIn 36 patients from 2 participating centers of the PROVHILO trial, we calculated respiratory system elastance (E), resistance (R), and %E2, a surrogate parameter for intratidal overdistension (%E2 > 30%) and R/D (%E2 < 0%). To test the main hypothesis, we compared the incidence of intratidal overdistension (primary end point) and R/D in higher and lower PEEP groups, as measured by %E2.
resultsE was increased in the lower compared to higher PEEP group (18.6 [16…22] vs 13.4 [11.0…17.0] cm H2O·L; P < .01). %E2 was reduced in the lower PEEP group compared to higher PEEP (-15.4 [-28.0…6.5] vs 6.2 [-0.8…14.0] %; P < .05). Intratidal R/D was increased in the lower PEEP group (61% vs 22%; P = .037). The incidence of intratidal overdistension did not differ significantly between groups (6%).
conclusionsDuring mechanical ventilation with protective tidal volumes in patients undergoing open abdominal surgery, lung recruitment followed by PEEP of 12 cm H2O decreased the incidence of intratidal R/D and did not worsen overdistension, when compared to PEEP ≤2 cm H2O.
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