European journal of anaesthesiology
-
Randomized Controlled Trial Comparative Study
The influence of perioperative oxygen concentration on postoperative lung function in moderately obese adults.
Obesity aggravates the negative effects of general anaesthesia and surgery on the respiratory system, resulting in decreased functional residual capacity and expiratory reserve volume, and increased atelectasis and ventilation/perfusion (Va/Q) mismatch. High-inspired oxygen concentrations also promote atelectasis. This study compares the effects of perioperative inspired low-oxygen and high-oxygen concentrations on postoperative lung function and pulse oximetry values in moderately obese patients (BMI 25-35). ⋯ We conclude that postoperative lung function and arterial saturation is better preserved by a low-oxygen strategy, although it is not clear whether this has clinical relevance for the prevention of postoperative pulmonary complications.
-
Comparative Study
Positive end-expiratory pressure improves end-expiratory lung volume but not oxygenation after induction of anaesthesia.
Induction of anaesthesia promotes collapse of dependent lung regions in both obese and nonobese patients. We hypothesized that end-expiratory lung volume (EELV) may be more sensitive than oxygenation to evaluate the effects of positive end-expiratory pressure (PEEP) after anaesthesia induction. ⋯ After induction of anaesthesia, mechanical ventilation with ZEEP is associated with a profound reduction in EELV. PEEP improves efficiently EELV and respiratory mechanics, with no major effect on oxygenation. EELV may be a useful indicator to guide PEEP setting in the operating room.
-
Comparative Study
Cardiac output derived from arterial pressure waveform analysis without calibration vs. thermodilution in septic shock: evolving accuracy of software versions.
We studied the evolution of software in the accuracy of the FloTrac/Vigileo system to measure cardiac output less invasively from arterial pressure waveform analysis without calibration, in comparison with pulmonary artery catheter-derived thermodilution measurements, in patients with septic shock and presumed alterations in vascular tone. ⋯ Evolving software versions are thus better able to account for the effect of vascular tone on cardiac output measurements by less invasive waveform analyses without calibration (FloTrac/Vigileo), so that the latter may become useful in the haemodynamic monitoring of septic shock.
-
Cuff-leak test predicts the severity of postextubation acute laryngeal lesions: a preliminary study.
The objectives of the present study were to evaluate the relationships between the results of the cuff-leak test and the presence of laryngeal lesions; to assess whether lesions needing pharmacological treatment and surveillance can be predicted by the cuff-leak test; and to analyse the relationships between these lesions and postextubation stridor. ⋯ Cuff-leak test is a simple, noninvasive tool, which may be useful to exclude, in patients with prolonged intubations, the presence of laryngeal injuries needing medical treatment and close monitoring. This occurs independently of postextubation stridor.