Artículo de Publicación Periódica:
Multimodal non‑invasive monitoring to apply an open lung approach strategy in morbidly obese patients during bariatric surgery

dc.contributor.authorTusman, Gerardo
dc.contributor.authorAcosta, Cecilia M.
dc.contributor.authorOchoa, Marcos
dc.contributor.authorBöhm, Stephan H.
dc.contributor.authorGogniat, Emiliano
dc.contributor.authorMartínez Arca, Jorge
dc.contributor.authorScandurra, Adriana
dc.contributor.authorMadorno, Matías
dc.contributor.authorFerrando, Carlos
dc.contributor.authorSuárez-Sipmann, Fernando
dc.date.accessioned2020-06-24T19:33:48Z
dc.date.available2020-06-24T19:33:48Z
dc.date.issued2019
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.issn1387-1307
dc.identifier.urihttp://ri.itba.edu.ar/handle/123456789/2222
dc.language.isoenen
dc.relationinfo:eu-repo/semantics/altIdentifier/doi/10.1007/s10877-019-00405-w
dc.subjectCAPNOGRAFIAes
dc.subjectOBESIDADes
dc.subjectCIRUGIA BARIATRICAes
dc.subjectPULMONESes
dc.subjectRESPIRACIONes
dc.titleMultimodal non‑invasive monitoring to apply an open lung approach strategy in morbidly obese patients during bariatric surgeryen
dc.typeArtículos de Publicaciones Periódicases
dc.typeinfo:eu-repo/semantics/acceptedVersion
dspace.entity.typeArtículo de Publicación Periódica
itba.description.filiationFil: Tusman, Gerardo. Hospital Privado de Comunidad; Argentina.
itba.description.filiationFil: Acosta, Cecilia M. Hospital Privado de Comunidad; Argentina.
itba.description.filiationFil: Ochoa, Marcos. Hospital Privado de Comunidad; Argentina.
itba.description.filiationFil: Böhm, Stephan H. Universitätsmedizin Rostock; Alemania.
itba.description.filiationFil: Gogniat, Emiliano. Sociedad Argentina de Terapia Intensiva; Argentina.
itba.description.filiationFil: Martínez Arca, Jorge. Universidad Nacional de Mar del Plata. Facultad de Ingeniería; Argentina.
itba.description.filiationFil: Scandurra, Adriana. Universidad Nacional de Mar del Plata. Facultad de Ingeniería; Argentina.
itba.description.filiationFil: Madorno, Matías. Instituto Tecnológico de Buenos Aires; Argentina.
itba.description.filiationFil: Ferrando, Carlos. Hospital Clínic de Barcelona; España.
itba.description.filiationFil: Suárez-Sipmann, Fernando. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias; España.
itba.description.filiationFil: Suárez-Sipmann, Fernando. Akademiska sjukhuset i Uppsala; Suecia.
itba.description.filiationFil: Suárez-Sipmann, Fernando. Hospital Universitario de La Princesa; España.

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