Change in stroke volume during alveolar recruitment maneuvers through transient continuous positive airway pressure or stepwise increase in positive end expiratory pressure in anesthetized patients: a prospective randomized double-blind study.
Changement du volume d’éjection au cours des manœuvres de recrutement alvéolaire par une pression positive continue transitoire ou une augmentation progressive de la pression expiratoire positive chez les patient·es anesthésié·es : une étude randomisée prospective à double insu.
alveolar recruitment
arterial hypotension
continuous positive airway pressure
positive end expiratory pressure
stroke volume
Journal
Canadian journal of anaesthesia = Journal canadien d'anesthesie
ISSN: 1496-8975
Titre abrégé: Can J Anaesth
Pays: United States
ID NLM: 8701709
Informations de publication
Date de publication:
28 Nov 2023
28 Nov 2023
Historique:
received:
14
04
2023
accepted:
23
07
2023
revised:
28
06
2023
medline:
29
11
2023
pubmed:
29
11
2023
entrez:
28
11
2023
Statut:
aheadofprint
Résumé
Intraoperative alveolar recruitment maneuvers (ARM) used during protective ventilation strategy may have severe adverse hemodynamic effects, reported mainly during abrupt continuous positive airway pressure (CPAP). Stepwise increase and decrease in positive end expiratory pressure (PEEP) may be used. We compared the hemodynamic effects of these two maneuvers. We enrolled patients scheduled for intermediate to high-risk surgery with continuous arterial pressure and stroke volume (esophageal Doppler) monitoring in a prospective, single-centre, randomized, double-blind study. After induction of anesthesia, we ensured preload independence of stroke volume before an ARM was randomly performed: 30 cm H Thirty-five patients were included in the CPAP and STEP groups. Mean (standard deviation) relative variation in stroke volume was -57 (24)% in the CPAP group and -32 (24)% in the STEP group (difference, -25; 95% confidence interval, -37 to -14; P < 0.001). Changes in systolic, mean, and diastolic arterial pressure over time were not different between groups. The ARM was stopped because of a systolic arterial pressure < 70 mm Hg in four patients in the CPAP group and in one patient in the STEP group. Alveolar recruitment maneuvers through stepwise increase and decrease in PEEP have a better hemodynamic tolerance than transient CPAP. ClinicalTrials.gov (NCT04802421); first submitted 15 March 2021. RéSUMé: OBJECTIF: Les manœuvres de recrutement alvéolaire (MRA) peropératoire utilisées pendant les stratégies de ventilation protectrice peuvent avoir des effets hémodynamiques indésirables graves, rapportés principalement lors d’une ventilation en pression positive continue (PPC ou CPAP en anglais) abrupte. L’augmentation et la diminution par étapes de la pression expiratoire positive (PEP) peuvent être utilisées. Nous avons comparé les effets hémodynamiques de ces deux manœuvres. MéTHODE: Nous avons recruté des patient·es devant bénéficier d’une chirurgie à risque intermédiaire à élevé avec monitorage continu de la tension artérielle et du volume d’éjection (Doppler œsophagien) dans le cadre d’une étude prospective, monocentrique, randomisée et à double insu. Après induction de l’anesthésie, nous nous sommes assurés de l’indépendance de précharge du volume d’éjection avant qu’une MRA ne soit effectuée au hasard : 30 cm H
Autres résumés
Type: Publisher
(fre)
RéSUMé: OBJECTIF: Les manœuvres de recrutement alvéolaire (MRA) peropératoire utilisées pendant les stratégies de ventilation protectrice peuvent avoir des effets hémodynamiques indésirables graves, rapportés principalement lors d’une ventilation en pression positive continue (PPC ou CPAP en anglais) abrupte. L’augmentation et la diminution par étapes de la pression expiratoire positive (PEP) peuvent être utilisées. Nous avons comparé les effets hémodynamiques de ces deux manœuvres. MéTHODE: Nous avons recruté des patient·es devant bénéficier d’une chirurgie à risque intermédiaire à élevé avec monitorage continu de la tension artérielle et du volume d’éjection (Doppler œsophagien) dans le cadre d’une étude prospective, monocentrique, randomisée et à double insu. Après induction de l’anesthésie, nous nous sommes assurés de l’indépendance de précharge du volume d’éjection avant qu’une MRA ne soit effectuée au hasard : 30 cm H
Identifiants
pubmed: 38017197
doi: 10.1007/s12630-023-02644-7
pii: 10.1007/s12630-023-02644-7
doi:
Banques de données
ClinicalTrials.gov
['NCT04802421']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. Canadian Anesthesiologists' Society.
Références
Zeng C, Lagier D, Lee JW, Vidal Melo MF. Perioperative pulmonary atelectasis: part I. Biology and mechanisms. Anesthesiology 2022; 136: 181–205. https://doi.org/10.1097/aln.0000000000003943
doi: 10.1097/aln.0000000000003943
pubmed: 34499087
Lundquist H, Hedenstierna G, Strandberg A, Tokics L, Brismar B. CT-assessment of dependent lung densities in man during general anaesthesia. Acta Radiol 1995; 36: 626–32.
doi: 10.1177/028418519503600464
pubmed: 8519574
Rothen HU, Sporre B, Engberg G, Wegenius G, Reber A, Hedenstierna G. Prevention of atelectasis during general anaesthesia. Lancet 1995; 345:1387–91. https://doi.org/10.1016/s0140-6736(95)92595-3
doi: 10.1016/s0140-6736(95)92595-3
pubmed: 7760608
Fernandez-Bustamante A, Frendl, G, Sprung J, et al. Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery. a multicenter study by the Perioperative Research Network investigators. JAMA Surg 2016; 152: 157–66. https://doi.org/10.1001/jamasurg.2016.4065
doi: 10.1001/jamasurg.2016.4065
Rothen RU, Sporre B, Enberg G, Wegenus G, Hedenstierna G. Re-expansion of atelectasis during general anaesthesia: a computed tomography study. Br J Anaesth 1993; 71: 788–95. https://doi.org/10.1093/bja/71.6.788
doi: 10.1093/bja/71.6.788
pubmed: 8280539
Futier E, Constantin JM, Paugam-Burtz C, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med Med 2013; 369: 428–37. https://doi.org/10.1056/nejmoa1301082
doi: 10.1056/nejmoa1301082
Ferrando C, Soro M, Unzueta C, et al. Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial. Lancet Respir Med 2018; 6:193–203. https://doi.org/10.1016/s2213-2600(18)30024-9
doi: 10.1016/s2213-2600(18)30024-9
pubmed: 29371130
Deng QW, Tan WC, Zhao BC, Wen SH, Shen JT, Xu M. Intraoperative ventilation strategies to prevent postoperative pulmonary complications: a network meta-analysis of randomised controlled trials. Br J Anaesth 2020; 124: 324–35. https://doi.org/10.1016/j.bja.2019.10.024
doi: 10.1016/j.bja.2019.10.024
pubmed: 32007240
Lagier D, Zeng C, Fernandez-Bustamante A, Vidal Melo MF. Perioperative pulmonary atelectasis: part II. Clinical implications. Anesthesiology 2022; 136: 206–36. https://doi.org/10.1097/aln.0000000000004009
doi: 10.1097/aln.0000000000004009
pubmed: 34710217
Lagier D, Fischer F, Fornier W, et al. 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 Med 2019; 45: 1401–12. https://doi.org/10.1007/s00134-019-05741-8
doi: 10.1007/s00134-019-05741-8
pubmed: 31576435
pmcid: 9889189
Writing Committee for the PROBESE Collaborative Group of the PROtective VEntilation Network (PROVEnet) for the Clinical Trial Network of the European Society of Anaesthesiology, Bluth T, Serpa Neto A, et al. Effect of intraoperative high positive end-expiratory pressure (PEEP) with recruitment maneuvers vs low PEEP on postoperative pulmonary complications in obese patients: a randomized clinical trial. JAMA 2019; 321: 2292–305. https://doi.org/10.1001/jama.2019.7505
Biais M, Lanchon R, Sesay M, et al. Changes in stroke volume induced by lung recruitment maneuver predict fluid responsiveness in mechanically ventilated patients in the operating room. Anesthesiology 2017; 126: 260–7. https://doi.org/10.1097/aln.0000000000001459
doi: 10.1097/aln.0000000000001459
pubmed: 27922547
Marini JJ. Recruitment by sustained inflation: time for a change. Intensive Care Med 2011; 37: 1572–4. https://doi.org/10.1007/s00134-011-2329-7
doi: 10.1007/s00134-011-2329-7
pubmed: 21858521
Celebi S, Köner Ö, Menda F, Korkut K, Suzer K, Cakar N. The pulmonary and hemodynamic effects of two different recruitment maneuvers after cardiac surgery. Anesth Analg 2007; 104: 384–90. https://doi.org/10.1213/01.ane.0000252967.33414.44
Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ 2010; 340: c332. https://doi.org/10.1136/bmj.c332
doi: 10.1136/bmj.c332
pubmed: 20332509
pmcid: 2844940
Kristensen SD, Knuuti J, Saraste A et al. 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: the Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur J Anaesth 2014; 31: 517–73. https://doi.org/10.1097/eja.0000000000000150
doi: 10.1097/eja.0000000000000150
Vallet B, Blanloeil Y, Cholley B, Orliguet G, Pierre S, Tavernier B. Guidelines for perioperative haemodynamic optimization. Ann Fr Anesth Reanim 2013; 32: e151–8. https://doi.org/10.1016/j.annfar.2013.09.010
doi: 10.1016/j.annfar.2013.09.010
pubmed: 24126197
Hanouz JL, Coquerel A, Persyn C, Radenac D, Gérard JL, Fischer MO. Changes in stroke volume during an alveolar recruitment maneuvers through a stepwise increase in positive end expiratory pressure and transient continuous positive airway pressure in anesthetized patients. A prospective observational pilot study. J Anaesthesiol Clin Pharmacol 2019; 35: 453–9. https://doi.org/10.4103/joacp.joacp_167_18
doi: 10.4103/joacp.joacp_167_18
pubmed: 31920227
pmcid: 6939576
Grasso S, Mascia L, Del Turco M, et al. Effects of recruiting maneuvers in patients with acute respiratory distress syndrome ventilated with protective ventilatory strategy. Anesthesiology 2002; 96: 795–802. https://doi.org/10.1097/00000542-200204000-00005
doi: 10.1097/00000542-200204000-00005
pubmed: 11964585
Daudel F, Gorrasi J, Bracht H, et al. Effects of lung recruitment maneuvers on splanchnic organ perfusion during endotoxin-induced pulmonary arterial hypertension. Shock 2010; 34: 488–94. https://doi.org/10.1097/shk.0b013e3181e03bfb
doi: 10.1097/shk.0b013e3181e03bfb
pubmed: 20357696
Nielsen J, Østergaard M, Kjaergaard J, et al. Lung recruitment maneuver depresses central hemodynamics in patients following cardiac surgery. Intensive Care Med 2005; 31: 1189–94. https://doi.org/10.1007/s00134-005-2732-z
doi: 10.1007/s00134-005-2732-z
pubmed: 16096751
Feldheiser A, Hunsicker O, Krebbel H, et al. Oesophageal Doppler and calibrated pulse contour analysis are not interchangeable within a goal-directed haemodynamic algorithm in major gynaecological surgery. Br J Anaesth 2014; 113: 822–31. https://doi.org/10.1093/bja/aeu241
doi: 10.1093/bja/aeu241
pubmed: 25107544
Choi ES, Oh AY, In CB, Ryu JH, Jeon YT, Kim HG. Effects of recruitment manoeuvre on perioperative pulmonary complications in patients undergoing robotic assisted radical prostatectomy: a randomised single-blinded trial. PLoS One 2017; 12: e0183311. https://doi.org/10.1371/journal.pone.0183311
doi: 10.1371/journal.pone.0183311
pubmed: 28877238
pmcid: 5587235
Santos RS, Moraes L, Samary CS, et al. Fast versus slow recruitment maneuver at different degrees of acute lung inflammation induced by experimental sepsis. Anesth Analg 2016; 122: 1089–100. https://doi.org/10.1213/ane.0000000000001173
doi: 10.1213/ane.0000000000001173
pubmed: 26836136