Multimodal non‑invasive monitoring to apply an open lung approach strategy in morbidly obese patients during bariatric surgery

Tusman, Gerardo; Acosta, Cecilia M.; Ochoa, Marcos; Böhm, Stephan H.; Gogniat, Emiliano; Martínez Arca, Jorge; Scandurra, Adriana; Madorno, Matías; Ferrando, Carlos; Suárez-Sipmann, Fernando

artículo de publicación periódica.page.titleprefix
Multimodal non‑invasive monitoring to apply an open lung approach strategy in morbidly obese patients during bariatric surgery

dc.contributor.author	Tusman, Gerardo
dc.contributor.author	Acosta, Cecilia M.
dc.contributor.author	Ochoa, Marcos
dc.contributor.author	Böhm, Stephan H.
dc.contributor.author	Gogniat, Emiliano
dc.contributor.author	Martínez Arca, Jorge
dc.contributor.author	Scandurra, Adriana
dc.contributor.author	Madorno, Matías
dc.contributor.author	Ferrando, Carlos
dc.contributor.author	Suárez-Sipmann, Fernando
dc.date.accessioned	2020-06-24T19:33:48Z
dc.date.available	2020-06-24T19:33:48Z
dc.date.issued	2019
dc.description.abstract	"To evaluate the use of non-invasive variables for monitoring an open-lung approach (OLA) strategy in bariatric surgery. Twelve morbidly obese patients undergoing bariatric surgery received a baseline protective ventilation with 8 cmH2O of positive-end expiratory pressure (PEEP). Then, the OLA strategy was applied consisting in lung recruitment followed by a decremental PEEP trial, from 20 to 8 cmH2O, in steps of 2 cmH2O to find the lung’s closing pressure. Baseline ventila-tion was then resumed setting open lung PEEP (OL-PEEP) at 2 cmH2O above this pressure. The multimodal non-invasive variables used for monitoring OLA consisted in pulse oximetry (SpO2), respiratory compliance (Crs), end-expiratory lung volume measured by a capnodynamic method (EELVCO2), and esophageal manometry. OLPEEP was detected at 15.9 ± 1.7 cmH2O corresponding to a positive end-expiratory transpulmonary pressure (PL,ee) of 0.9 ± 1.1 cmH2O. ROC analysis showed that SpO2 was more accurate (AUC 0.92, IC95% 0.87–0.97) than Crs (AUC 0.76, IC95% 0.87–0.97) and EELVCO2 (AUC 0.73, IC95% 0.64–0.82) to detect the lung’s closing pressure according to the change of PL,ee from positive to negative values. Compared to baseline ventilation with 8 cmH2O of PEEP, OLA increased EELVCO2 (1309 ± 517 vs. 2177 ± 679 mL) and decreased driving pressure (18.3 ± 2.2 vs. 10.1 ± 1.7 cmH2O), estimated shunt (17.7 ± 3.4 vs. 4.2 ± 1.4%), lung strain (0.39 ± 0.07 vs. 0.22 ± 0.06) and lung elastance (28.4 ± 5.8 vs. 15.3 ± 4.3 cmH2O/L), respectively; all p < 0.0001. The OLA strategy can be monitored using noninvasive variables during bariatric surgery. This strategy decreased lung strain, elastance and driving pressure compared with standard protective ventilatory settings."	en
dc.identifier.issn	1387-1307
dc.identifier.uri	http://ri.itba.edu.ar/handle/123456789/2222
dc.language.iso	en	en
dc.relation	info:eu-repo/semantics/altIdentifier/doi/10.1007/s10877-019-00405-w
dc.subject	CAPNOGRAFIA	es
dc.subject	OBESIDAD	es
dc.subject	CIRUGIA BARIATRICA	es
dc.subject	PULMONES	es
dc.subject	RESPIRACION	es
dc.title	Multimodal non‑invasive monitoring to apply an open lung approach strategy in morbidly obese patients during bariatric surgery	en
dc.type	Artículos de Publicaciones Periódicas	es
dc.type	info:eu-repo/semantics/acceptedVersion
dspace.entity.type	Artículo de Publicación Periódica
itba.description.filiation	Fil: Tusman, Gerardo. Hospital Privado de Comunidad; Argentina.
itba.description.filiation	Fil: Acosta, Cecilia M. Hospital Privado de Comunidad; Argentina.
itba.description.filiation	Fil: Ochoa, Marcos. Hospital Privado de Comunidad; Argentina.
itba.description.filiation	Fil: Böhm, Stephan H. Universitätsmedizin Rostock; Alemania.
itba.description.filiation	Fil: Gogniat, Emiliano. Sociedad Argentina de Terapia Intensiva; Argentina.
itba.description.filiation	Fil: Martínez Arca, Jorge. Universidad Nacional de Mar del Plata. Facultad de Ingeniería; Argentina.
itba.description.filiation	Fil: Scandurra, Adriana. Universidad Nacional de Mar del Plata. Facultad de Ingeniería; Argentina.
itba.description.filiation	Fil: Madorno, Matías. Instituto Tecnológico de Buenos Aires; Argentina.
itba.description.filiation	Fil: Ferrando, Carlos. Hospital Clínic de Barcelona; España.
itba.description.filiation	Fil: Suárez-Sipmann, Fernando. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias; España.
itba.description.filiation	Fil: Suárez-Sipmann, Fernando. Akademiska sjukhuset i Uppsala; Suecia.
itba.description.filiation	Fil: Suárez-Sipmann, Fernando. Hospital Universitario de La Princesa; España.