Intra-Operative PEEP Vs ZEEP
Intra-Operative PEEP Vs ZEEP
Intra-Operative PEEP Vs ZEEP
PPCs.
Introduction
• Many clinical trials have investigated the use of intraoperative
radiation.
Study Design
Canada.
Inclusion Criteria
• Patient refusal
• ASA IV, V
• Severe COPD
Anaesthesia Protocol
• Pre-oxygenation with 100% of O2 for 3 minutes.
surgery
• Desflurane/Sevoflurane
• Volume controlled ventilation; tidal volume 8ml/kg ; frequency 12 bpm ; EtCO2 30-
40mmHg
• PEEP/RM group
• PEEP of 7 cm H2O
• ZEEP Group:
• No recruitment manouver/PEEP
Lung Ultrasound
• Performed with GE Logic e ultrasound machine using curvilinear
probe (2-5MHz)
• Each zone was divided into upper and lower portion leading to a
total of 12 quadrants.
• LUS was calculated for each quadrant and then was added up
for all 12 quadrants for every patient.
B - Lines
Coalesced B Lines
Secondary Outcomes
• At each time point:
• FiO2
– Induction duration
• Maintenance:
– Fluid balance
Explanatory Variables
• Emergence:
– Postoperative pain
– Cough severity
Results
Results
• Mean LUS was similar in both groups before induction of GA.
group
arrival in PACU.
Results
• Secondary Outcomes:
• In PEEP group:
– PaO2 and FiO2 ratio increased with the use of PEEP and RM during GA
• In ZEEP group:
• Explanatory Analyses:
loss.
Discussion
• Combination of PEEP and recruitment manouver improves lung aeration
during GA lasting for more than 2 hours.
• Higher PaO2:FiO2 ratio and lower driving pressure was also achieved with
PEEP and RM.
• 3 major indications:
ventilator settings
Physiology of PEEP
• 2. Barotrauma
metabolism
Recruitment Manoeuvres
possible
Recruitment Manoeuvres
• Sigmoid curve - Different areas of
lungs open at different pressures
• Opening pressure can range from
few cm H2O to as high as 55-60cm
H2O
• Compression atelectasis / loose
atelectasis - seen after induction in
GA
• Opening pressure for compression
atelectasis: Around 20cm H2O
• Most RMs are performed with
pressure sustained for 40 sec or
more.
Complications of Recruitment
Manoeuvres
1. Hypotension
2. Hypoxemia
3. Barotrauma
4. Pneumothorax
5. Subcutaneous emphysema
6. Pneumomediastinum
Conclusion
• PEEP and RM prevent intra-operative atelectasis significantly.