Effect of permissive hypercapnia on perioperative pulmonary inflammatory response in patients undergoing thoracoscopic combined with laparoscopic esophagectomy / 中华内分泌外科杂志

Objective:To study the effect of permissive hypercapnia on pulmonary infection in patients underwent thoracoscopic combined with laparoscopic radical esophagectomy.Methods:From 2018 to 2020, 90 who patients underwent thoracoscopic laparoscopy combined with radical esophagectomy were divided into 3 groups by random who number table method, including 30 patients in experimental group 1, 30 patients in experimental group 2, and 30 patients in control group.PaCO 2 was maintained in the range of 56 mmHg-65 mmHg in experimental group 1, 46 mmHg-55 mmHg in experimental group 2 and 35 mmHg-45 mmHg in control group. The peak airway pressure (Ppeak) , lung dynamic compliance (Cdyn) and oxygenation index (OI) were observed and compared among the three groups after endotracheal intubation (T1) , 30 min after right artificial pneumothorax (T2) and 30 min after right lung recruitment (T3) ;The clinical pulmonary infection score (CPIS) , serum procalcitonin (PCT) on the 1st, 4th and 7th day after operation were analyzed and compared. Results:At T2, observation group A had the highest dynamic lung compliance (25.13 ± 5.70 vs 22.28 ± 4.26 vs 19.99 ± 4.36), the fastest heart rate (102.04 ± 10.91 vs 96.46 ± 9.91 vs 92.28 ± 8.08) and the lowest airway pressure (17.62 ± 1.79 vs 18.96 ± 1.90 vs 20.39 ± 1.71) ( P < 0.05). Observation group A had the lowest CPIS on the 1st, 4th and 7th day after operation compared with observation group B and control group (1.12±0.77 vs 1.71±0.90 vs 2.64±1.07) (6.08±1.20 vs 7.43±1.10 vs 8.31±1.55) (1.69±1.12 vs 2.32±0.98 vs 3.44±1.25) ( P<0.05) . Conclusion:Permissive hypercapnia can reduce airway resistance, improve lung compliance and reduce the risk of postoperative pulmonary infection.

The Adequacy of a Conventional Mechanical Ventilator as a Ventilation Method during Cardiopulmonary Resuscitation: A Manikin Study / 대한중환자의학회지

BACKGROUND: We conducted this study to verify whether a mechanical ventilator is adequate for cardiopulmonary resuscitation (CPR). METHODS: A self-inflating bag resuscitator and a mechanical ventilator were used to test two experimental models: Model 1 (CPR manikin without chest compression) and Model 2 (CPR manikin with chest compression). Model 2 was divided into three subgroups according to ventilator pressure limits (P(limit)). The self-inflating bag resuscitator was set with a ventilation rate of 10 breaths/min with the volume-marked bag-valve procedure. The mode of the mechanical ventilator was set as follows: volume-controlled mandatory ventilation of tidal volume (Vt) 600 mL, an inspiration time of 1.2 seconds, a constant flow pattern, a ventilation rate of 10 breaths/minute, a positive end expiratory pressure of 3 cmH2O and a maximum trigger limit. Peak airway pressure (P(peak)) and Vt were measured by a flow analyzer. Ventilation adequacy was determined at a Vt range of 400-600 mL with a P(peak) of < or = 50 cmH2O. RESULTS: In Model 1, Vt and P(peak) were in the appropriate range in the ventilation equipments. In Model 2, for the self-inflating bag resuscitator, the adequate Vt and P(peak) levels were 17%, and the P(peak) adequacy was 20% and the Vt was 65%. For the mechanical ventilator, the adequate Vt and P(peak) levels were 85%; the P(peak) adequacy was 85%; and the Vt adequacy was 100% at 60 cmH2O of P(limit). CONCLUSIONS: In a manikin model, a mechanical ventilator was superior to self-inflating bag resuscitator for maintaining adequate ventilation during chest compression.

The Adequacy of a Conventional Mechanical Ventilator as a Ventilation Method during Cardiopulmonary Resuscitation: A Manikin Study / 대한구급학회지

BACKGROUND: We conducted this study to verify whether a mechanical ventilator is adequate for cardiopulmonary resuscitation (CPR). METHODS: A self-inflating bag resuscitator and a mechanical ventilator were used to test two experimental models: Model 1 (CPR manikin without chest compression) and Model 2 (CPR manikin with chest compression). Model 2 was divided into three subgroups according to ventilator pressure limits (P(limit)). The self-inflating bag resuscitator was set with a ventilation rate of 10 breaths/min with the volume-marked bag-valve procedure. The mode of the mechanical ventilator was set as follows: volume-controlled mandatory ventilation of tidal volume (Vt) 600 mL, an inspiration time of 1.2 seconds, a constant flow pattern, a ventilation rate of 10 breaths/minute, a positive end expiratory pressure of 3 cmH2O and a maximum trigger limit. Peak airway pressure (P(peak)) and Vt were measured by a flow analyzer. Ventilation adequacy was determined at a Vt range of 400-600 mL with a P(peak) of < or = 50 cmH2O. RESULTS: In Model 1, Vt and P(peak) were in the appropriate range in the ventilation equipments. In Model 2, for the self-inflating bag resuscitator, the adequate Vt and P(peak) levels were 17%, and the P(peak) adequacy was 20% and the Vt was 65%. For the mechanical ventilator, the adequate Vt and P(peak) levels were 85%; the P(peak) adequacy was 85%; and the Vt adequacy was 100% at 60 cmH2O of P(limit). CONCLUSIONS: In a manikin model, a mechanical ventilator was superior to self-inflating bag resuscitator for maintaining adequate ventilation during chest compression.

The effects of different mechanical ventilation flow model on the peak airway pressure during cardiopulmonary resuscitation / 中华危重病急救医学

Objective To observe the method of mechanical ventilation in the chest compressions during cardiopulmonary resuscitation (CPR),and to explore the influence of the flow pattern selection of square-wave and decelerating-wave on airway pressure of patients. Methods A prospective self-pairing study was conducted. Forty patients undergoing CPR admitted to Department of Emergency of Lishui City Central Hospital from January 2011 to February 2013 were enrolled. Using Respironics Eisprit ventilator,the working mode and parameters of ventilator were set reasonably according to previous research,while the chest compressions was performed in a stable state by the same doctor,. Each patient received different flow,waves,including square-wave and decelerating-wave,and the highest peak airway pressure was recorded as a pair of data when the time-pressure and time-flow waveform were frozen. Two pairs of data by different doctors were collected in each patient. Eighty pairs of data from 40 patients were collected for statistical analysis by paired t test. Results The highest peak airway pressure of decelerating-wave was (38.15± 5.99)cmH2O (1 cmH2O=0.098 kPa),which was (5.71±1.98)cmH2O lower than that of square wave 〔(43.86± 6.68)cmH2O〕with significantly statistical difference(t=22.010,P=0.000). 73.75%patients undergoing square wave with peak airway pressure over 40 cmH2O were found,but only 45.00% patients were found in decelerating-wave. Conclusion Because decelerating-wave used in mechanical ventilation during CPR can obviously reduce the peak airway pressure,the occurrence of barotrauma,and the probability of triggering high pressure ventilator alarm,and improve the compliance of ventilator,so decelerating-wave is more reasonable than square-wave.

Positioning of double lumen endobronchial tube by three combined ethods with fibroptic bronchoscope / 临床麻醉学杂志

Objective To observe the correctly positioning rate of left-sided double lumen endobronchial tube by combined adjustment of auscultation,PETCO2 and airway pressure changes.Methods Sixty adult patients undergoing thoracic surgery were intubated with Robertshaw DLTs. DLT position is checked and adjusted by fiberoptic bronchoscope（FOB）. Results In the supine position,successful intubation is 57 cases by three combined methods,one of cases is shallower,two of cases are deeper,satisfactory rate is 95 percents;In the lateral decubitus position,successful intobution is 56 cases by three combined methods,two of cases is shallower,two of cases are deeper,satisfactory rate is 93.4 percents.Conclusion Three combined methods that are simple,reliable can be used repeatedly during postural changes without increasing the opportunities for injury,it is clinically a very good approach,but the absolute scope of safety is very small,FOB is necessary for positioning.

Hydrothorax Detected at Postanesthetic Care Unit after Percutaneous Nephrolithotomy: A case report / 대한마취과학회지

Percutaneous nephrolithotomy (PCNL) is a well-established procedure for treating nearly all types of stones in the kidneys and middle-to-upper ureters. In addition, PCNL is less invasive, and provides safe results comparable to open surgery. However, there is risk of an increased risk of thoracic complications when performing a puncture above the 12 th rib to optimize kidney access. We experienced a 30-years-old female who had oxygen desaturation and complained dyspnea and chest pain at the postanesthetic care unit after percutaneous nephrolithotomy. Therefore, patients undergoing percutaneous renal manipulation need to be monitored for pulmonary complications during and after the procedure.

The Effect on Pulmonary Function after Abdominoplasty

Theoretically one might suggest the abdominoplasty can cause respiratory decompensation resulting from musculofascial plication, which reduces the respiratory reserve by decreasing intra-abdominal volume and diaphragmatic excursion. This prospective study was perfomed to evaluate the effect of abdominoplasty and the change of intraoperative Paw on the pulmonary function of 20 consecutive otherwise healthy subjects. The pulmonary function test was performed preoperatively, and repeated 2 months after the operation. Additionally, we monitored intraoperative Paw. Comparison of the pulmonary function test showed a significant decrease(p<0.001) in the mean forced vital capacity(FVC) and the mean forced expiratory volume in one second(FEV1) throughout the study period. Postoperatively, the mean FVC decreased by 11.65% and the mean FEV1 decreased by 16.15%. The mean Paw increased by 6.6cmH2O(3-12cmH2O) by musculofascial plication. And we found that the decrease in FVC and FEV1 was significantly correlated with intraoperative changing of Paw in abdominoplasty(p<0.001). FVC and FEV1 could be decreased by abdominoplasty due to decreasing intra-abdominal volume and diaphragmatic excursion, but there was no respiratory symptom clinically in all patients 2 months after the operation. In conclusion, We found that the decrease in FVC and FEV1 after 2 months of abdominoplasty was significantly correlated with intraoperative Paw change during operation. The intraoperative Paw was increased to 12 cmH2O without any respiratory symptom in this study. We suggested that the increase in intraoperative Paw less than about 10cmH2O can not affect on respiratory function clinically.

Changes in Respiratory Compliance and Peak Airway Pressure during a Laparoscopic Cholecystectomy in the Elderly / 대한마취과학회지

BACKGROUND: The advantage of a laparoscopic cholecystectomy has led to a trend toward performing it in the elderly. It is well recognised that this can cause changes in respiratory mechanics. However, few studies have measured the effects of abdominal insufflation with CO2 in the elderly. This study was done to evaluate changes in respiratory compliance and peak airway pressure during a laparoscopic cholecystectomy. METHODS: Thirty patients undergoing a laparoscopic cholecystectomy were divided into two groups; aged 65 years or more (elderly group) and under 60 years (control group). A pneumoperitoneum up to an intraabdominal pressure of 12 mmHg was created with CO2 insufflation. Respiratory and peak airway pressure were measured with a continuous spirometry. Measurements were obtained pre-insufflation, just after CO2 insufflation, at 15, 30, 45 and 60 minutes and after abdominal deflation. RESULTS: In both groups, respiratory compliance decreased significantly (P < 0.05) and equally by about 40% after CO2 insufflation. The decrement continued during the pneumoperitoneum, the changes were not significant between the groups. Each group showed an equal improvement immediately after abdominal deflation. No differences between the peak airway pressure during a laparoscopic cholecystectomy was seen in either group. CONCLUSIONS: We have demonstrated that during a laparoscopic cholecystectomy in the elderly the respiratory compliance decreased and peak airway pressure significantly increased as in the control group.

Increased Peak Inspiratory Pressure Due to Intraluminal Bulging of the Inner Layer of the Reinforced Wire Tube during Anesthesia: A case report / 대한마취과학회지

Excessive peak airway pressure during general endotracheal anesthesia may result from bronchospasm due to light anesthesia or surgical stimulation, bronchial intubation, tension pneumothorax, pulmonary edema, or mechanical obstruction of tube, whether from kinking, inspissated secretions, or overinflation of the cuff. Usually these problems are differentiated with auscultation and drug administration. However, mechanical problems associated with the endotracheal tube may be a cause of increased airway pressure. Reinforced, anode, or armored tubes consist of two coatings of latex or PVC that enclose spiral metal windings. Because of that, the inner layer may peel away, and intraluminally bulge due to nitrous oxide and cause airway obstruction during the course of an anesthetic process. We report a case of intraluminal bulging of the inner layer in a reinforced tube using fiberoptic bronchoscopy during anesthesia.