Ventilation distribution assessed with electrical impedance tomography and the influence of tidal volume, recruitment and positive end-expiratory pressure in isoflurane-anesthetized dogs.
Ambrosio, Aline M.; Carvalho-Kamakura, Tatiana P. A.; Ida, Keilaet al.
2017 • In Veterinary Anaesthesia and Analgesia, 44 (2), p. 254-263
Ventilation distribution assessed with electrical impedance tomography and the influence of tidal volume, recruitment and positive end-expiratory pressure in isoflurane-anesthetized dogs.pdf
pressure-controlled ventilation; pulmonary atelectasis; pulmonary gas exchange; respiratory mechanics
Abstract :
[en] OBJECTIVE: To examine the intrapulmonary gas distribution of low and high tidal volumes (VT) and to investigate whether this is altered by an alveolar recruitment maneuver (ARM) and 5 cmH2O positive end-expiratory pressure (PEEP) during anesthesia. STUDY DESIGN: Prospective randomized clinical study. ANIMALS: Fourteen client-owned bitches weighing 26 +/- 7 kg undergoing elective ovariohysterectomy. METHODS: Isoflurane-anesthetized dogs in dorsal recumbency were ventilated with 0 cmH2O PEEP and pressure-controlled ventilation by adjusting the peak inspiratory pressure (PIP) to achieve a low (7 mL kg-1; n = 7) or a high (12 mL kg-1; n = 7) VT. Ninety minutes after induction (T90), an ARM (PIP 20 cmH2O for 10 seconds, twice with a 10 second interval) was performed followed by the application of 5 cmH2O PEEP for 35 minutes (RM35). The vertical (ventral=0%; dorsal=100%) and horizontal (right=0%; left=100%) center of ventilation (CoV), four regions of interest (ROI) (ventral, central-ventral, central-dorsal, dorsal) identified in electrical impedance tomography images, and cardiopulmonary data were analyzed using two-way repeated measures anova. RESULTS: The low VT was centered in more ventral (nondependent) areas compared with high VT at T90 (CoV: 38.8 +/- 2.5% versus 44.6 +/- 7.2%; p = 0.0325). The ARM and PEEP shifted the CoV towards dorsal (dependent) areas only during high VT (50.5 +/- 7.9% versus 41.1 +/- 2.8% during low VT, p = 0.0108), which was more distributed to the central-dorsal ROI compared with low VT (p = 0.0046). The horizontal CoV was centrally distributed and cardiovascular variables remained unchanged throughout regardless of the VT, ARM, and PEEP. CONCLUSIONS AND CLINICAL RELEVANCE: Both low and high VT were poorly distributed to dorsal dependent regions, where ventilation was improved following the current ARM and PEEP only during high VT. Studies on the role of high VT on pulmonary complications are required.
Disciplines :
Veterinary medicine & animal health
Author, co-author :
Ambrosio, Aline M.
Carvalho-Kamakura, Tatiana P. A.
Ida, Keila ; Université de Liège > Dép. clinique des animaux de compagnie et des équidés (DCA) > Anesthésiologie et réanimation vétérinaires
Varela, Barbara
Andrade, Felipe S. R. M.
Faco, Lara L.
Fantoni, Denise T.
Language :
English
Title :
Ventilation distribution assessed with electrical impedance tomography and the influence of tidal volume, recruitment and positive end-expiratory pressure in isoflurane-anesthetized dogs.
Publication date :
2017
Journal title :
Veterinary Anaesthesia and Analgesia
ISSN :
1467-2987
eISSN :
1467-2995
Publisher :
Elsevier, New York, United States - New York
Volume :
44
Issue :
2
Pages :
254-263
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
Copyright (c) 2017 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.
Adamicza, A., Tutsek, L., Nagy, S., Changes in transthoracic electrical impedance during endotoxemia in dogs. Acta Physiol Hung 85 (1997), 291–302.
Adler, A., Amyot, R., Guardo, R., et al. Monitoring changes in lung air and liquid volumes with electrical impedance tomography. J App Physiol 83 (1997), 1762–1767.
Adler, A., Shinozuka, N., Berthiaume, Y., et al. Electrical impedance tomography can monitor dynamic hyperinflation in dogs. J App Physiol 84 (1998), 726–732.
Blankman, P., Hasan, D., Erik, G., Gommers, D., Detection of ‘best’ positive end-expiratory pressure derived from electrical impedance tomography parameters during a decremental positive end-expiratory pressure trial. Crit Care, 18, 2014, R95.
Bradbrook, C.A., Clark, L., Dugdale, A.H., et al. Measurement of respiratory system compliance and respiratory system resistance in healthy dogs undergoing general anaesthesia for elective orthopaedic procedures. Vet Anaesth Analg 40 (2013), 382–389.
Canfran, S., Gomez de Segura, I.A., Cediel, R., et al. Effects of a stepwise lung recruitment manoeuvre and positive end-expiratory pressure on lung compliance and arterial blood oxygenation in healthy dogs. Vet J 194 (2012), 89–93.
De Monte, V., Grasso, S., De Marzo, C., et al. Effects of reduction of inspired oxygen fraction or application of positive end-expiratory pressure after an alveolar recruitment maneuver on respiratory mechanics, gas exchange, and lung aeration in dogs during anesthesia and neuromuscular blockade. Am J Vet Res 74 (2013), 25–33.
Fantoni, D.T., Ida, K.K., Lopes, T.F.T., et al. A comparison of the cardiopulmonary effects of pressure controlled ventilation and volume controlled ventilation in healthy anesthetized dogs. J Vet Emerg Crit Care 26 (2016), 524–530.
Flaherty, D., Auckburally, A., Muscle relaxants. Seymour, C., Duke-Novakovski, T., (eds.) BSAVA Manual of Canine and Feline Anaesthesia and Analgesia, 2nd edn, 2007, Lookers, UK, 156–165.
Frerichs, I., Becher, T., Weiler, N., Methodology of electrical impedance tomography-derived measures of regional lung ventilation. Crit Care, 18, 2014, 635.
Frerichs, I., Dargaville, P.A., van Genderingen, H., et al. Lung volume recruitment after surfactant administration modifies spatial distribution of ventilation. Am J Resp Crit Care Med 174 (2006), 772–779.
Guldner, A., Kiss, T., Serpa Neto, A., et al. Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers. Anesthesiology 123 (2015), 692–713.
Hedenstierna, G., Sandhagen, B., Assessing dead space. A meaningful variable?. Minerva Anestesiol 72 (2006), 521–528.
Moens, Y., Coppens, P., Patient monitoring and monitoring equipment. Seymour, C., Duke-Novakovski, T., (eds.) BSAVA Manual of Canine and Feline Analgesia and Anaesthesia, 2nd edn, 2007, Lookers, UK, 62–78.
Newell, J.C., Edic, P.M., Ren, X., et al. Assessment of acute pulmonary edema in dogs by electrical impedance imaging. IEEE Trans Biomed Eng 43 (1996), 133–138.
Oura, T., Rozanski, E.A., Buckley, G., Bedenice, D., Low tidal volume ventilation in healthy dogs. J Vet Emerg Crit Care 22 (2012), 368–371.
Rothen, H.U., Sporre, B., Engberg, G., et al. Prevention of atelectasis during general anaesthesia. Lancet 345 (1995), 1387–1391.
Staffieri, F., Franchini, D., Carella, G.L., et al. Computed tomographic analysis of the effects of two inspired oxygen concentrations on pulmonary aeration in anesthetized and mechanically ventilated dogs. Am J Vet Res 68 (2007), 925–931.
Staffieri, F., Centonze, P., Gigante, G., et al. Comparison of the analgesic effects of robenacoxib, buprenorphine and their combination in cats after ovariohysterectomy. Vet J 197 (2013), 363–367.
Swanson, C.R., Muir, W.W. 3rd, Hemodynamic and respiratory responses in halothane-anesthetized horses exposed to positive end-expiratory pressure alone and with dobutamine. Am J Vet Res 49 (1988), 539–542.
