European journal of anaesthesiology
-
Randomized Controlled Trial
Effects of two stepwise lung recruitment strategies on respiratory function and haemodynamics in anaesthetised pigs: A randomised crossover study.
Lung recruitment manoeuvres and positive end-expiratory pressure (PEEP) can improve lung function during general anaesthesia. Different recruitment manoeuvre strategies have been described in large international trials: in the protective ventilation using high vs. low PEEP (PROVHILO) strategy, tidal volume (VT) was increased during volume-controlled ventilation; in the individualised peri-operative open-lung approach vs. standard protective ventilation in abdominal surgery (iPROVE) strategy, PEEP was increased during pressure-controlled ventilation. ⋯ In anaesthetised pigs, the iPROVE strategy compared with the PROVHILO strategy increased dorsal Ptrans at the cost of lower MAP during recruitment manoeuvres, and decreased ERS thereafter, without consistent improvement of oxygenation or shift of the CoV.
-
Observational Study
Clinical performance of a machine-learning algorithm to predict intra-operative hypotension with noninvasive arterial pressure waveforms: A cohort study.
Intra-operative hypotension is associated with adverse postoperative outcomes. A machine-learning-derived algorithm developed to predict hypotension based on arterial blood pressure (ABP) waveforms significantly reduced intra-operative hypotension. The algorithm calculates the likelihood of hypotension occurring within minutes, expressed as the Hypotension Prediction Index (HPI) which ranges from 0 to 100. Currently, HPI is only available for patients monitored with invasive ABP, which is restricted to high-risk procedures and patients. In this study, the performance of HPI, employing noninvasive continuous ABP measurements, is assessed. ⋯ This study demonstrated that the algorithm can be employed using continuous noninvasive ABP waveforms. This opens up the potential to predict and prevent hypotension in a larger patient population.