Araos Joaquin D, Lacitignola Luca, Stripoli Tania, Grasso Salvatore, Crovace Antonio, Staffieri Francesco
Centre Hospitalier Universitaire Veterinaire, Faculte de Medecine Veterinaire, Universite de Montreal, Québec, Canada.
Surgery Unit, Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation D.E.O.T., "Aldo Moro" University of Bari, Bari, Italy.
Vet Anaesth Analg. 2019 Nov;46(6):780-788. doi: 10.1016/j.vaa.2019.04.016. Epub 2019 Jun 26.
To evaluate the effects of positive end-expiratory pressure (PEEP) alone and PEEP preceded by lung recruitment manoeuvre (LRM) on lung volumes and respiratory system mechanics in healthy horses undergoing general anaesthesia.
Controlled, prospective clinical study.
A group of 15 horses undergoing arthroscopy.
Following anaesthetic induction, initial ventilatory settings were: tidal volume 15 mL kg, inspiratory:expiratory ratio 1:2, respiratory rate to maintain end-tidal CO between 5.3-6.6 kPa (40-50 mmHg). The following settings were implemented sequentially: zero PEEP (ZEEP); PEEP 10 cmHO (PEEP); LRM (50 cmHO for 20 seconds) followed by 10 cmHO of PEEP (LRM + PEEP). Static compliance (C), driving pressure, delta end-expiratory (ΔEELV) and recruited lung volumes (RLV) were obtained 30 minutes after initiating each ventilatory strategy. Data were analyzed with paired t test or analysis of variance followed by Tukey's post hoc test. Data are shown as mean ± standard deviation; p < 0.05 was considered significant.
PEEP induced ΔEELV of 6.68 ± 3.36 mL kg; ΔEELV during LRM + PEEP was 14.28 ± 5.59 mL kg (p < 0.0001). The RLV was greater during the LRM + PEEP phase (12.30 ± 5.85 mL kg) than during PEEP (4.47 ± 3.97 mL kg; p < 0.0001). The C was unchanged from ZEEP to PEEP (0.75 ± 0.21 and 0.85 ± 0.22 mL cmHO kg, respectively, p = 0.36) but increased using LRM + PEEP (1.11 ± 0.25 mL cmHO kg, p = 0.0004). Driving pressure was lower during LRM + PEEP than during PEEP and ZEEP (16 ± 2, 19 ± 2 and 21 ± 4 cmHO, respectively, p < 0.0001).
Unlike PEEP alone, PEEP preceded by LRM increased RLV and C and reduced driving pressure in horses under anaesthesia.
评估在接受全身麻醉的健康马匹中，单纯呼气末正压通气（PEEP）以及在肺复张手法（LRM）后使用PEEP对肺容量和呼吸系统力学的影响。
对照性前瞻性临床研究。
一组15匹接受关节镜检查的马。
麻醉诱导后，初始通气设置为：潮气量15 mL/kg，吸呼比1:2，呼吸频率维持呼气末二氧化碳分压在5.3 - 6.6 kPa（40 - 50 mmHg）之间。依次实施以下设置：零PEEP（ZEEP）；10 cmH₂O的PEEP（PEEP）；LRM（50 cmH₂O持续20秒）后接10 cmH₂O的PEEP（LRM + PEEP）。在每种通气策略开始30分钟后获取静态顺应性（C）、驱动压、呼气末容积变化（ΔEELV）和肺复张容积（RLV）。数据采用配对t检验或方差分析，随后进行Tukey事后检验。数据以平均值±标准差表示；p < 0.05被认为具有显著性。
PEEP诱导的ΔEELV为6.68±3.36 mL/kg；LRM + PEEP期间的ΔEELV为14.28±5.59 mL/kg（p < 0.0001）。LRM + PEEP阶段的RLV（12.30±5.85 mL/kg）大于PEEP阶段（4.47±3.97 mL/kg；p < 0.0001）。从ZEEP到PEEP，C无变化（分别为0.75±0.21和0.85±0.22 mL/cmH₂O/kg，p = 0.36），但使用LRM + PEEP时C增加（1.11±0.25 mL/cmH₂O/kg，p = 0.0004）。LRM + PEEP期间的驱动压低于PEEP和ZEEP期间（分别为16±2、19±2和21±4 cmH₂O，p < 0.0001）。
与单纯PEEP不同，在麻醉马匹中，LRM后使用PEEP可增加RLV和C，并降低驱动压。
