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Critical Care (London, England) May 2016Partial extracorporeal CO2 removal allows a decreasing tidal volume without respiratory acidosis in patients with acute respiratory distress syndrome. This, however, may...
Partial extracorporeal CO2 removal allows a decreasing tidal volume without respiratory acidosis in patients with acute respiratory distress syndrome. This, however, may be associated with worsening hypoxemia, due to several mechanisms, such as gravitational and reabsorption atelectasis, due to a decrease in mean airway pressure and a critically low ventilation-perfusion ratio, respectively. In addition, an imbalance between alveolar and artificial lung partial pressures of nitrogen may accelerate the process. Finally, the decrease in the respiratory quotient, leading to unrecognized alveolar hypoxia and monotonous low plateau pressures preventing critical opening, may contribute to hypoxemia.
Topics: Humans; Pulmonary Atelectasis; Respiration, Artificial; Respiratory Distress Syndrome; Tidal Volume; Ventilation-Perfusion Ratio
PubMed: 27170273
DOI: 10.1186/s13054-016-1310-9 -
BMC Pulmonary Medicine Jul 2021Partnership between anesthesia providers and proceduralists is essential to ensure patient safety and optimize outcomes. A renewed importance of this axiom has emerged...
Partnership between anesthesia providers and proceduralists is essential to ensure patient safety and optimize outcomes. A renewed importance of this axiom has emerged in advanced bronchoscopy and interventional pulmonology. While anesthesia-induced atelectasis is common, it is not typically clinically significant. Advanced guided bronchoscopic biopsy is an exception in which anesthesia protocols substantially impact outcomes. Procedure success depends on careful ventilation to avoid excessive motion, reduce distortion causing computed tomography (CT)-to-body-divergence, stabilize dependent areas, and optimize breath-hold maneuvers to prevent atelectasis. Herein are anesthesia recommendations during guided bronchoscopy. An FiO of 0.6 to 0.8 is recommended for pre-oxygenation, maintained at the lowest tolerable level for the entire the procedure. Expeditious intubation (not rapid-sequence) with a larger endotracheal tube and non-depolarizing muscle relaxants are preferred. Positive end-expiratory pressure (PEEP) of up to 10-12 cm HO and increased tidal volumes help to maintain optimal lung inflation, if tolerated by the patient as determined during recruitment. A breath-hold is required to reduce motion artifact during intraprocedural imaging (e.g., cone-beam CT, digital tomosynthesis), timed at the end of a normal tidal breath (peak inspiration) and held until pressures equilibrate and the imaging cycle is complete. Use of the adjustable pressure-limiting valve is critical to maintain the desired PEEP and reduce movement during breath-hold maneuvers. These measures will reduce atelectasis and CT-to-body divergence, minimize motion artifact, and provide clearer, more accurate images during guided bronchoscopy. Following these recommendations will facilitate a successful lung biopsy, potentially accelerating the time to treatment by avoiding additional biopsies. Application of these methods should be at the discretion of the anesthesiologist and the proceduralist; best medical judgement should be used in all cases to ensure the safety of the patient.
Topics: Anesthesia, General; Breath Holding; Bronchoscopy; Humans; Intraoperative Complications; Lung; Positive-Pressure Respiration; Pulmonary Atelectasis; Tomography, X-Ray Computed
PubMed: 34273966
DOI: 10.1186/s12890-021-01584-6 -
Tidsskrift For Den Norske Laegeforening... Jun 2018
Topics: Aged; Bronchoscopy; Foreign-Body Migration; Humans; Male; Pulmonary Atelectasis; Tomography, X-Ray Computed
PubMed: 29893103
DOI: 10.4045/tidsskr.17.1025 -
Minerva Anestesiologica May 2002Pulmonary gas exchange is regularly impaired during general anaesthesia with mechanical ventilation. This results in decreased oxygenation of blood. Major causes are... (Review)
Review
Pulmonary gas exchange is regularly impaired during general anaesthesia with mechanical ventilation. This results in decreased oxygenation of blood. Major causes are collapse of lung tissue (atelectasis) and airway closure. Collapsed lung tissue is present in 90% of all subjects, both during spontaneous breathing and after muscle paralysis, and whether intravenous or inhalational anaesthetics are used. Airway closure is also common and increases in magnitude with increasing age of the patient. There are correlation between the amount of atelectasis and pulmonary shunt and between airway closure and perfusion of poorly ventilated lung regions (low VA/Q). Atelectasis and airway closure explain as much as 74% of gas exchange impairment in routine anaesthesia. A major cause of atelectasis is the pre-oxygenation during induction of anaesthesia. Lowering the inspired O2 concentration to 80% suffices to avoid almost all atelectasis. Airway closure and low VA/Q can only be prevented by raising the FRC level by PEEP or by other means.
Topics: Airway Obstruction; Anesthesia; Humans; Pulmonary Atelectasis; Pulmonary Gas Exchange
PubMed: 12029240
DOI: No ID Found -
Anesthesiology Jun 2022
Topics: Humans; Lung; Positive-Pressure Respiration; Pulmonary Atelectasis; Respiration
PubMed: 35362085
DOI: 10.1097/ALN.0000000000004194 -
BioMed Research International 2015Atelectasis caused by lung injury leads to increased intrapulmonary shunt, venous admixture, and hypoxaemia. Lung recruitment manoeuvres aim to quickly reverse this... (Review)
Review
Atelectasis caused by lung injury leads to increased intrapulmonary shunt, venous admixture, and hypoxaemia. Lung recruitment manoeuvres aim to quickly reverse this scenario by applying increased airway pressures for a short period of time which meant to open the collapsed alveoli. Although the procedure can improve oxygenation, but due to the heart-lung and right and left ventricle interactions elevated intrathoracic pressures can inflict serious effects on the cardiovascular system. The purpose of this paper is to give an overview on the pathophysiological background of the heart-lung interactions and the best way to monitor these changes during lung recruitment.
Topics: Animals; Heart; Hemodynamics; Humans; Positive-Pressure Respiration; Pulmonary Alveoli; Pulmonary Atelectasis; Respiration
PubMed: 26682219
DOI: 10.1155/2015/478970 -
Journal of Orthopaedic Surgery and... Jan 2021The aim of the present study was to explore the therapeutic effect and prognosis in patients with rib fractures and atelectasis after thoracic trauma in order to provide...
BACKGROUND
The aim of the present study was to explore the therapeutic effect and prognosis in patients with rib fractures and atelectasis after thoracic trauma in order to provide a basis for clinical decision-making in primary hospitals.
METHODS
A retrospective study was conducted on 86 patients admitted to our hospital between January 2016 and May 2020 with rib fractures and atelectasis after thoracic trauma. On the basis of the chest computed tomography scans taken at the time of discharge, the patients were divided into two groups: the reexpansion group and the non-reexpansion group. The two groups were compared with respect to the changes observed in the patients' levels of blood oxygen saturation (SpO2) and pulmonary function, the presence of secondary pulmonary or thoracic infection, the time of chest tube drainage, the length of hospitalization, the cost of hospitalization, and the patients' level of satisfaction with their quality of life 3 months after discharge.
RESULTS
In the reexpansion group, there were significant differences in the levels of SpO2 and pulmonary function measured before and after pulmonary reexpansion (P < 0.05). Compared with the non-reexpansion group, the patients in the reexpansion group had a lower incidence of secondary pulmonary and thoracic infection and a higher level of satisfaction with their quality of life after discharge; these differences were statistically significant (P < 0.05). There was no statistical significance between the two groups with respect to the time of chest tube drainage or the length of hospitalization (P > 0.05). However, the cost of hospitalization was significantly higher in the reexpansion group than in the non-reexpansion group (P < 0.05).
CONCLUSIONS
The patients in the pulmonary reexpansion group had a lower incidence of complications and a better prognosis than the patients in the non-reexpansion group.
Topics: Adult; Aged; Aged, 80 and over; Chest Tubes; Decision Making; Drainage; Female; Fracture Fixation; Humans; Length of Stay; Male; Middle Aged; Patient Satisfaction; Prognosis; Pulmonary Atelectasis; Retrospective Studies; Rib Fractures; Thoracic Injuries; Thoracic Surgical Procedures; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
PubMed: 33509201
DOI: 10.1186/s13018-021-02221-y -
Acta Veterinaria Scandinavica Sep 2022Computed tomography (CT) scanning of the lung is known to be a valuable tool when investigating lung pathology of the dog. During CT-scan the dog needs to be immobilized...
BACKGROUND
Computed tomography (CT) scanning of the lung is known to be a valuable tool when investigating lung pathology of the dog. During CT-scan the dog needs to be immobilized and general anesthesia has historically been considered as gold standard although being a more expensive and time-consuming alternative to sedation. Today, modern high speed multidetector CT-scanners offer new possibilities for sedation as an alternative. Both anesthesia and sedation can cause lung atelectasis, and this can be problematic when reading the CT-images since it potentially can masque or mimic lung pathology leading to misdiagnosis. The objective of this prospective analytic study was to investigate the prevalence of lung atelectasis and changes in lung attenuation over time in dogs that receive intravenous sedation and positioned in sternal recumbency.
RESULTS
20 dogs without known lung pathology underwent three consecutive CT-scans of the lung; the first scan was initiated as soon as the dog was sufficiently sedated, the second scan approximately 5 min after the first one and the last scan after the dog's orthopaedic scan was completed. The dogs received intravenous sedation in a combination of dexmedetomidine and butorphanol and were kept positioned in a strict sternal recumbency during sedation and exam. Each lung lobe was individually examined in an axial plane and measurements of dorsal, ventral, and mean lung attenuation were made. Atelectasis or areas with poorly aerated lung tissue were not detected as all parts of the lobes were normally aerated at all three scans. A statistically significant increase in lung attenuation between the first and the second scan (P = 0.03) and between the first and the third scan (P = 0.0004) was seen in the ventral part of the lobes.
CONCLUSIONS
This study indicates that CT-examination of the lungs can be performed on sedated dogs that are kept in a sternal recumbency without development of atelectasis. It also suggests that there is an early correlation between time and increase in lung attenuation.
Topics: Anesthesia, General; Animals; Dog Diseases; Dogs; Lung; Prevalence; Prospective Studies; Pulmonary Atelectasis; Tomography, X-Ray Computed
PubMed: 36076254
DOI: 10.1186/s13028-022-00643-0 -
Minerva Anestesiologica Jun 2008
Review
Topics: Humans; Intraoperative Complications; Postoperative Complications; Pulmonary Atelectasis
PubMed: 18500199
DOI: No ID Found -
Anesthesiology Jul 2022
Topics: Humans; Lung; Pulmonary Atelectasis
PubMed: 35486841
DOI: 10.1097/ALN.0000000000004231