Open AccessPOSITIVE END EXPIRATORY PRESSURE (PEEP);
Author(s) -
Usman Razzaque,
Raheel Azhar,
Tassadaq Khurshid,
Khalid Zaeem,
Syed Abdul Majid
Publication year - 2012
Publication title -
the professional medical journal/the professional medical journal
Language(s) - English
Resource type - Journals
eISSN - 2071-7733
pISSN - 1024-8919
DOI - 10.29309/tpmj/2012.19.01.1953
Subject(s) - medicine , positive end expiratory pressure , anesthesia , oxygenation , pneumothorax , mechanical ventilation , ventilation (architecture) , functional residual capacity , lung , prone position , lung volumes , surgery , mechanical engineering , engineering
Introduction: Thoracic surgeries and aesthesia for lung resection has presented anaesthesiologists with certain uniquephysiological problems. These include placing (lateral decubitus position) in order to obtain optimal access for most operations on lungs, pleura,esophagus, and great vessels, opening the chest wall (open pneumothorax) and one lung ventilation anaesthesia. One lung ventilationanaesthesia and lateral decubitus position produces decrease in functional residual capacity and an obligatory right to left shunt that rangesfrom 15% to 40% leading to increase in ventilation perfusion (V/Q) mismatch thus causing hypoxia and or hypoxemia. An optimal level ofpositive end expiratory pressure of 5cmH O when added to dependent lung is known to improve arterial oxygenation and improve ventilator 2efficiency. Objectives: To compare different values of positive end expiratory pressure (PEEP) during one lung ventilation, for its effects onblood arterial oxygenation and carbon dioxide levels. Study Design: Randomized controlled trial (RCT). Setting: Conducted in surgical Unit-IIIand Department of anaesthesia and Intensive Care, Combined Military Hospital, Rawalpindi. Duration of study with dates: Ten months from25-12-2008 to 01-10-2009, Additional quantum of Data was collected from 01-01-2011 to 25-01-2011. Subjects and methods: The patientswere divided into two equal groups of 100 patients each, by random allocation of patients to either in-group A (subjected to zero PEEP) or group-B (subjected to PEEP 5cm of water). Results: At induction and start of two lung ventilation 14 (14.0%) of the patients from group-A and 16(16.0%) from group-B had normal PaCO . At initiation of one lung ventilation 25 (25.0%) of the patients from group-A and 80 (80.0%) from group- 2B had normal PaO . At initiation of one lung ventilation 26 (26.0%) of the patients from group-A and 80 (80.0%) from group-B had normal PaCO 2 2with p <0.001. At end of procedure one lung ventilation 30 (30.0%) of the patients from group-A and 90 (90.0%) from group-B had normal PaO . 2At end of procedure one lung ventilation 32 (32.0%) of the patients from group-A and 91 (91.0%) from group-B had normal PaCO . 2Conclusions: The execution of one-lung ventilation still constitutes a challenge in clinical and surgical practice.