Definition and clinical evaluation of a recruiting airway pressure based on the specific lung elastance in anesthetized dogs |
| |
| Authors: | Joaquin Araos Luca Lacitignola Claudia Acquafredda Caterina DiBella Marzia Stabile Erica Guacci Robin Gleed Salvatore Grasso Antonio Crovace Francesco Staffieri |
| |
| Institution: | 1. Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA;2. Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation D.E.O.T., “Aldo Moro” University of Bari, Bari, Italy;3. Section of Anesthesia and Intensive Care, Department of Emergency and Organ Transplantation D.E.O.T., “Aldo Moro” University of Bari, Bari, Italy |
| |
| Abstract: | ObjectiveTo determine the specific lung elastance (SEL) in anesthetized dogs and to evaluate the efficacy of a SEL-based recruiting airway pressure (RPaw) at improving global and regional lung aeration.Study designRetrospective and prospective clinical study.AnimalsA total of 28 adult dogs were included in the retrospective study and six adult dogs in the prospective study.MethodsRetrospective study: SEL and SEL-based RPaw were determined using previously published data. In mechanically ventilated dogs undergoing thoracic computed tomography (CT), SEL was calculated as ΔPL/(VT/EELV), where ΔPL is the driving transpulmonary pressure, VT is the tidal volume and EELV is the end-expiratory lung volume. The ratio of lung to respiratory system elastance (EL/Ers) was determined. SEL and EL/Ers were used to calculate the SEL-based RPaw. Prospective study: dogs underwent thoracic CT at end-expiration and at end-inspiration using the SEL-based RPaw, and global and regional aeration was determined. For analysis of regional aeration, lungs were divided into cranial, intermediate and caudal regions. Regional compliance was also calculated. A p value <0.05 was considered significant.ResultsThe SEL and EL/Ers were 12.7 ± 3.1 cmH2O and 0.54 ± 0.07, respectively. The SEL-based RPaw was 29.1 ± 7.6 cmH2O. In the prospective study, the RPaw was 28.2 ± 1.3 cmH2O. During RPaw, hyperinflation increased (p = 0.0003) whereas poorly aerated (p < 0.0001) and nonaerated (p = 0.01) tissue decreased. Normally aerated tissue did not change (p = 0.265). Regional compliance was higher in the intermediate (p = 0.0003) and caudal (p = 0.034) regions compared with the cranial region. Aeration did not differ between regions (p > 0.05).Conclusions and clinical relevanceAn SEL-based RPaw reduces poorly and nonaerated lung tissue in anesthetized dogs. In nonsurgical anesthetized dogs, an RPaw near 30 cmH2O is effective at improving lung aeration. |
| |
| Keywords: | anesthesia alveolar recruitment atelectasis dogs specific lung elastance |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
