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

Journal of Anaesthesiology Clinical Pharmacology. 2019;35(4):453-459 DOI 10.4103/joacp.JOACP_167_18

 

Journal Homepage

Journal Title: Journal of Anaesthesiology Clinical Pharmacology

ISSN: 0970-9185 (Print); 2231-2730 (Online)

Publisher: Wolters Kluwer Medknow Publications

Society/Institution: Research Society of Anaesthesiology Clinical Pharmacology

LCC Subject Category: Medicine: Surgery: Anesthesiology | Medicine: Pharmacy and materia medica

Country of publisher: India

Language of fulltext: English

Full-text formats available: PDF, HTML, ePUB

 

AUTHORS


Jean Luc Hanouz

Axel Coquerel

Christophe Persyn

Dorothée Radenac

Jean Louis Gérard

Marc Olivier Fischer

EDITORIAL INFORMATION

Double blind peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 50 weeks

 

Abstract | Full Text

Background and Aims: Recruitment maneuvers may be used during anesthesia as part of perioperative protective ventilation strategy. However, the hemodynamic effect of recruitment maneuvers remain poorly documented in this setting. Material and Methods: This was a prospective observational study performed in operating theatre including patients scheduled for major vascular surgery. Patients were monitored with invasive arterial pressure and esophageal doppler. After induction of general anesthesia, before surgery began, preload optimization based on stroke volume (SV) variation following fluid challenge was performed. Then, an alveolar recruitment maneuver (ARM) through stepwise increase in positive end expiratory pressure (PEEP) or continuous positive airway pressure (CPAP) was performed. Hemodynamic data were noted before, during, and after the alveolar recruitment maneuver. Results: ARM through stepwise increase in PEEP and CPAP were applied in 22 and 14 preload independent patients, respectively. Relative changes in SV during ARMs were significantly greater in the ARMCPAPgroup (-39 ± 20%) as compared to the ARMPEEPgroup (-15 ± 22%; P= 0.002). The difference (95% CI) in relative decrease in SV between ARMCPAPand ARMPEEPgroups was -24% (-38 to -9; P= 0.001). Changes in arterial pressure, cardiac index, pulse pressure variation, peak velocity, and corrected flow time measures were not different between groups. Conclusion: During anesthesia, in preload independent patients, ARMs through CPAP resulted in a significantly greater decrease in SV than stepwise increase in PEEP. During anesthesia, ARM should be used cautiously.