Publication: Efectos del reclutamiento alveolar y la presión positiva al final de la espiración óptima sobre la distensibilidad del sistema respiratorio y la oxigenación arterial en perros durante la anestesia general
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2022-10-06
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Universidad Complutense de Madrid
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Abstract
Las maniobras de reclutamiento alveolar (MRA), seguidas del empleo de presión positiva al final de la espiración (PEEP), pueden utilizarse para prevenir o tratar las atelectasias pulmonares durante la anestesia general. En medicina humana se recomienda individualizar el valor de PEEP y aplicar la PEEP óptima en cada paciente después de la MRA. En personas sanas, la realización de MRA seguidas del empleo de PEEP mejora la distensibilidad del sistema respiratorio (Dsr) y la oxigenación arterial intraoperatoria y podría mejorar la oxigenación arterial postoperatoria. En perros sanos, la realización de MRA seguidas de una PEEP fija (no individualizada al paciente) de 4o 5 cmH2O mejora la Dsr y la oxigenación arterial intraoperatoria, pero no se ha evaluado el efecto de las MRA seguidas de PEEP óptima (individualizada al paciente) sobre la Dsr durante la anestesia y la oxigenación arterial postoperatoria. Además, se desconocen los factores que afectan ala PEEP óptima y la Dsr después de una MRA. Esta Tesis Doctoral incluyó tres ensayos clínicos con tres objetivos diferentes. En el ensayo clínico 1, se evaluó el efecto de una MRA progresiva, seguida de PEEP óptima, sobre la Dsr y se comparó con el de la ventilación mecánica sin PEEP o con una PEEP fija de 5 cmH2O sin MRA previa. En el ensayo clínico 2, se evaluó el efecto de la posición y la condición corporal del paciente sobre el valor de PEEP óptima y la Dsr después de una MRA progresiva. En el ensayo clínico 3,se evaluó el efecto de una MRA progresiva, seguida de PEEP óptima, sobre la oxigenación arterial postoperatoria temprana y se comparó con el de la ventilación espontánea y la ventilación mecánica sin PEEP...
Alveolar recruitment manoeuvres (ARMs), followed by the application of positive end-expiratory pressure (PEEP), can be used to prevent or treat lung atelectasis during general anaesthesia. In human medicine, the individualization of PEEP and the application of optimal PEEP after ARM in each patient are recommended. In healthy people, ARMs followed by the use of PEEP improve respiratory system compliance (Crs) and intraoperative arterial oxygenation and could also improve postoperative arterial oxygenation. In healthy dogs, ARMs followed by a fixed PEEP (not individualized to patient) of 4 or 5 cmH2O improve Crs and intraoperative arterial oxygenation, but the effect of ARMs followed by optimal PEEP (individualized to patient) on Crs during anaesthesia and postoperative arterial oxygenation has not been assessed. Besides, factors affecting the optimal PEEP and Crs following ARM in this species are unknown.This thesis included three clinical studies and objectives. In clinical study 1, the aim was to assess the effect of a stepwise ARM, followed by optimal PEEP, on Crs and to compare it to those of controlled mechanical ventilation without PEEP or with a fixed PEEP of 5 cmH2O without previous ARM. In clinical study 2, the aim was to assess the effect of patient’s recumbency and body condition score on optimal PEEP value and Crs following stepwise ARM. In clinical study 3, the objective was to assess the effect of a stepwise ARM, followed by optimal PEEP, on early postoperative arterial oxygenation and to compare it to those of spontaneous ventilation and controlled mechanical ventilation without PEEP...
Alveolar recruitment manoeuvres (ARMs), followed by the application of positive end-expiratory pressure (PEEP), can be used to prevent or treat lung atelectasis during general anaesthesia. In human medicine, the individualization of PEEP and the application of optimal PEEP after ARM in each patient are recommended. In healthy people, ARMs followed by the use of PEEP improve respiratory system compliance (Crs) and intraoperative arterial oxygenation and could also improve postoperative arterial oxygenation. In healthy dogs, ARMs followed by a fixed PEEP (not individualized to patient) of 4 or 5 cmH2O improve Crs and intraoperative arterial oxygenation, but the effect of ARMs followed by optimal PEEP (individualized to patient) on Crs during anaesthesia and postoperative arterial oxygenation has not been assessed. Besides, factors affecting the optimal PEEP and Crs following ARM in this species are unknown.This thesis included three clinical studies and objectives. In clinical study 1, the aim was to assess the effect of a stepwise ARM, followed by optimal PEEP, on Crs and to compare it to those of controlled mechanical ventilation without PEEP or with a fixed PEEP of 5 cmH2O without previous ARM. In clinical study 2, the aim was to assess the effect of patient’s recumbency and body condition score on optimal PEEP value and Crs following stepwise ARM. In clinical study 3, the objective was to assess the effect of a stepwise ARM, followed by optimal PEEP, on early postoperative arterial oxygenation and to compare it to those of spontaneous ventilation and controlled mechanical ventilation without PEEP...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Veterinaria, Departamento de Medicina y Cirugía Animal, leída el 11-03-2022