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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.identifier.issn1387-1307
dc.identifier.urihttp://ri.itba.edu.ar/handle/123456789/2222
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.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
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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