Effects of individualised positive end-expiratory pressure titration on respiratory and haemodynamic parameters during the Trendelenburg position with pneumoperitoneum: a randomised crossover physiologic trial
BACKGROUND: The Trendelenburg position with pneumoperitoneum during surgery promotes dorsobasal atelectasis formation, which impairs respiratory mechanics and increases lung stress and strain. Positive end-expiratory pressure (PEEP) can reduce pulmonary inhomogeneities and preserve end-expiratory lu...
Gespeichert in:
| Hauptverfasser: | , , , , , , , , , , , |
|---|---|
| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
November 2023
|
| In: |
European journal of anaesthesiology
Year: 2023, Jahrgang: 40, Heft: 11, Pages: 817-825 |
| ISSN: | 1365-2346 |
| DOI: | 10.1097/EJA.0000000000001894 |
| Online-Zugang: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1097/EJA.0000000000001894 Verlag, lizenzpflichtig, Volltext: https://journals.lww.com/ejanaesthesiology/fulltext/2023/11000/effects_of_individualised_positive_end_expiratory.3.aspx 
|
| Verfasserangaben: | Christoph Boesing, Laura Schaefer, Jochen Johannes Schoettler, Alena Quentin, Grietje Beck, Manfred Thiel, Patrick Honeck, Karl-Friedrich Kowalewski, Paolo Pelosi, Patricia R.M. Rocco, Thomas Luecke and Joerg Krebs |
MARC
| LEADER | 00000caa a2200000 c 4500 | ||
|---|---|---|---|
| 001 | 187713936X | ||
| 003 | DE-627 | ||
| 005 | 20240307031822.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240103s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1097/EJA.0000000000001894 |2 doi | |
| 035 | |a (DE-627)187713936X | ||
| 035 | |a (DE-599)KXP187713936X | ||
| 035 | |a (OCoLC)1425208000 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rda | ||
| 041 | |a eng | ||
| 084 | |a 33 |2 sdnb | ||
| 100 | 1 | |a Bösing, Christoph |d 1992- |e VerfasserIn |0 (DE-588)1273295285 |0 (DE-627)1823064353 |4 aut | |
| 245 | 1 | 0 | |a Effects of individualised positive end-expiratory pressure titration on respiratory and haemodynamic parameters during the Trendelenburg position with pneumoperitoneum |b a randomised crossover physiologic trial |c Christoph Boesing, Laura Schaefer, Jochen Johannes Schoettler, Alena Quentin, Grietje Beck, Manfred Thiel, Patrick Honeck, Karl-Friedrich Kowalewski, Paolo Pelosi, Patricia R.M. Rocco, Thomas Luecke and Joerg Krebs |
| 264 | 1 | |c November 2023 | |
| 300 | |b Illustrationen | ||
| 300 | |a 9 | ||
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a Computermedien |b c |2 rdamedia | ||
| 338 | |a Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Online veröffentlicht: 30. August 2023 | ||
| 500 | |a Gesehen am 03.01.2024 | ||
| 520 | |a BACKGROUND: The Trendelenburg position with pneumoperitoneum during surgery promotes dorsobasal atelectasis formation, which impairs respiratory mechanics and increases lung stress and strain. Positive end-expiratory pressure (PEEP) can reduce pulmonary inhomogeneities and preserve end-expiratory lung volume (EELV), resulting in decreased inspiratory strain and improved gas-exchange. The optimal intraoperative PEEP strategy is unclear. OBJECTIVE(S): To compare the effects of individualised PEEP titration strategies on set PEEP levels and resulting transpulmonary pressures, respiratory mechanics, gas-exchange and haemodynamics during Trendelenburg position with pneumoperitoneum. DESIGN: Prospective, randomised, crossover single-centre physiologic trial. SETTING: University hospital. PATIENTS:Thirty-six patients receiving robot-assisted laparoscopic radical prostatectomy. INTERVENTION(S): Randomised sequence of three different PEEP strategies: standard PEEP level of 5 cmH2O (PEEP5), PEEP titration targeting a minimal driving pressure (PEEPΔP) and oesophageal pressure-guided PEEP titration (PEEPPoeso) targeting an end-expiratory transpulmonary pressure (PTP) of 0 cmH2O. MAIN OUTCOME MEASURES: The primary endpoint was the PEEP level when set according to PEEPΔP and PEEPPoeso compared with PEEP of 5 cmH2O. Secondary endpoints were respiratory mechanics, lung volumes, gas-exchange and haemodynamic parameters. RESULTS: PEEP levels differed between PEEPΔP, PEEPPoeso and PEEP5 (18.0 [16.0 to 18.0] vs. 20.0 [18.0 to 24.0]vs. 5.0 [5.0 to 5.0] cmH2O; P < 0.001 each). End-expiratory PTP and lung volume were lower in PEEPΔP compared with PEEPPoeso (P = 0.014 and P < 0.001, respectively), but driving pressure, lung stress, as well as respiratory system and dynamic elastic power were minimised using PEEPΔP (P < 0.001 each). PEEPΔP and PEEPPoeso improved gas-exchange, but PEEPPoeso resulted in lower cardiac output compared with PEEP5 and PEEPΔP. CONCLUSION: PEEPΔP ameliorated the effects of Trendelenburg position with pneumoperitoneum during surgery on end-expiratory PTP and lung volume, decreased driving pressure and dynamic elastic power, as well as improved gas-exchange while preserving cardiac output. TRIAL REGISTRATION: German Clinical Trials Register (DRKS00028559, date of registration 2022/04/27). https://drks.de/search/en/trial/DRKS00028559 | ||
| 700 | 1 | |a Schaefer, Laura |e VerfasserIn |4 aut | |
| 700 | 1 | |a Schöttler, Jochen |d 1987- |e VerfasserIn |0 (DE-588)1065390432 |0 (DE-627)816069131 |0 (DE-576)425067858 |4 aut | |
| 700 | 1 | |a Quentin, Alena |e VerfasserIn |4 aut | |
| 700 | 1 | |a Beck, Grietje |d 1965- |e VerfasserIn |0 (DE-588)114399360 |0 (DE-627)647300117 |0 (DE-576)337555028 |4 aut | |
| 700 | 1 | |a Thiel, Manfred |d 1959- |e VerfasserIn |0 (DE-588)1029136874 |0 (DE-627)732482313 |0 (DE-576)376589213 |4 aut | |
| 700 | 1 | |a Honeck, Patrick |d 1975- |e VerfasserIn |0 (DE-588)129336912 |0 (DE-627)394253884 |0 (DE-576)297606875 |4 aut | |
| 700 | 1 | |a Kowalewski, Karl-Friedrich |d 1989- |e VerfasserIn |0 (DE-588)1100724192 |0 (DE-627)859518825 |0 (DE-576)469770740 |4 aut | |
| 700 | 1 | |a Pelosi, Paolo |e VerfasserIn |4 aut | |
| 700 | 1 | |a Rocco, Patricia R. M. |e VerfasserIn |4 aut | |
| 700 | 1 | |a Luecke, Thomas |e VerfasserIn |4 aut | |
| 700 | 1 | |a Krebs, Jörg |d 1978- |e VerfasserIn |0 (DE-588)131961713 |0 (DE-627)516320017 |0 (DE-576)298863081 |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t European journal of anaesthesiology |d Philadelphia, Pa. : Lippincott Williams & Wilkins, 1996 |g 40(2023), 11 vom: Nov., Seite 817-825 |h Online-Ressource |w (DE-627)320441350 |w (DE-600)2004964-X |w (DE-576)09095467X |x 1365-2346 |7 nnas |a Effects of individualised positive end-expiratory pressure titration on respiratory and haemodynamic parameters during the Trendelenburg position with pneumoperitoneum a randomised crossover physiologic trial |
| 773 | 1 | 8 | |g volume:40 |g year:2023 |g number:11 |g month:11 |g pages:817-825 |g extent:9 |a Effects of individualised positive end-expiratory pressure titration on respiratory and haemodynamic parameters during the Trendelenburg position with pneumoperitoneum a randomised crossover physiologic trial |
| 856 | 4 | 0 | |u https://doi.org/10.1097/EJA.0000000000001894 |x Verlag |x Resolving-System |z lizenzpflichtig |3 Volltext |
| 856 | 4 | 0 | |u https://journals.lww.com/ejanaesthesiology/fulltext/2023/11000/effects_of_individualised_positive_end_expiratory.3.aspx |x Verlag |z lizenzpflichtig |3 Volltext |
| 951 | |a AR | ||
| 992 | |a 20240103 | ||
| 993 | |a Article | ||
| 994 | |a 2023 | ||
| 998 | |g 131961713 |a Krebs, Jörg |m 131961713:Krebs, Jörg |d 60000 |d 61600 |e 60000PK131961713 |e 61600PK131961713 |k 0/60000/ |k 1/60000/61600/ |p 12 |y j | ||
| 998 | |g 1100724192 |a Kowalewski, Karl-Friedrich |m 1100724192:Kowalewski, Karl-Friedrich |d 60000 |d 63100 |e 60000PK1100724192 |e 63100PK1100724192 |k 0/60000/ |k 1/60000/63100/ |p 8 | ||
| 998 | |g 129336912 |a Honeck, Patrick |m 129336912:Honeck, Patrick |d 60000 |e 60000PH129336912 |k 0/60000/ |p 7 | ||
| 998 | |g 1029136874 |a Thiel, Manfred |m 1029136874:Thiel, Manfred |d 60000 |d 61600 |e 60000PT1029136874 |e 61600PT1029136874 |k 0/60000/ |k 1/60000/61600/ |p 6 | ||
| 998 | |g 114399360 |a Beck, Grietje |m 114399360:Beck, Grietje |d 60000 |d 61600 |e 60000PB114399360 |e 61600PB114399360 |k 0/60000/ |k 1/60000/61600/ |p 5 | ||
| 998 | |g 1065390432 |a Schöttler, Jochen |m 1065390432:Schöttler, Jochen |d 60000 |e 60000PS1065390432 |k 0/60000/ |p 3 | ||
| 998 | |g 1273295285 |a Bösing, Christoph |m 1273295285:Bösing, Christoph |d 60000 |e 60000PB1273295285 |k 0/60000/ |p 1 |x j | ||
| 999 | |a KXP-PPN187713936X |e 4446585711 | ||
| BIB | |a Y | ||
| SER | |a journal | ||
| JSO | |a {"name":{"displayForm":["Christoph Boesing, Laura Schaefer, Jochen Johannes Schoettler, Alena Quentin, Grietje Beck, Manfred Thiel, Patrick Honeck, Karl-Friedrich Kowalewski, Paolo Pelosi, Patricia R.M. Rocco, Thomas Luecke and Joerg Krebs"]},"language":["eng"],"person":[{"family":"Bösing","role":"aut","given":"Christoph","display":"Bösing, Christoph"},{"display":"Schaefer, Laura","given":"Laura","family":"Schaefer","role":"aut"},{"family":"Schöttler","role":"aut","given":"Jochen","display":"Schöttler, Jochen"},{"family":"Quentin","role":"aut","display":"Quentin, Alena","given":"Alena"},{"display":"Beck, Grietje","given":"Grietje","role":"aut","family":"Beck"},{"display":"Thiel, Manfred","given":"Manfred","role":"aut","family":"Thiel"},{"given":"Patrick","display":"Honeck, Patrick","family":"Honeck","role":"aut"},{"display":"Kowalewski, Karl-Friedrich","given":"Karl-Friedrich","role":"aut","family":"Kowalewski"},{"role":"aut","family":"Pelosi","given":"Paolo","display":"Pelosi, Paolo"},{"role":"aut","family":"Rocco","display":"Rocco, Patricia R. M.","given":"Patricia R. M."},{"role":"aut","family":"Luecke","given":"Thomas","display":"Luecke, Thomas"},{"role":"aut","family":"Krebs","display":"Krebs, Jörg","given":"Jörg"}],"recId":"187713936X","note":["Online veröffentlicht: 30. August 2023","Gesehen am 03.01.2024"],"title":[{"subtitle":"a randomised crossover physiologic trial","title":"Effects of individualised positive end-expiratory pressure titration on respiratory and haemodynamic parameters during the Trendelenburg position with pneumoperitoneum","title_sort":"Effects of individualised positive end-expiratory pressure titration on respiratory and haemodynamic parameters during the Trendelenburg position with pneumoperitoneum"}],"type":{"bibl":"article-journal","media":"Online-Ressource"},"physDesc":[{"extent":"9 S.","noteIll":"Illustrationen"}],"id":{"eki":["187713936X"],"doi":["10.1097/EJA.0000000000001894"]},"relHost":[{"titleAlt":[{"title":"EJA"}],"disp":"Effects of individualised positive end-expiratory pressure titration on respiratory and haemodynamic parameters during the Trendelenburg position with pneumoperitoneum a randomised crossover physiologic trialEuropean journal of anaesthesiology","type":{"media":"Online-Ressource","bibl":"periodical"},"pubHistory":["Nachgewiesen 13.1996,2 -"],"note":["Gesehen am 18.04.2024"],"language":["eng"],"part":{"pages":"817-825","extent":"9","issue":"11","text":"40(2023), 11 vom: Nov., Seite 817-825","volume":"40","year":"2023"},"origin":[{"publisherPlace":"Philadelphia, Pa. ; New York, NY ; Riverwoods, Ill. ; London [u.a.] ; Cambridge","dateIssuedKey":"1996","dateIssuedDisp":"1996-","publisher":"Lippincott Williams & Wilkins ; Ovid ; Wolters Kluwer Health ; Wiley ; Univ. Pr."}],"title":[{"title_sort":"European journal of anaesthesiology","title":"European journal of anaesthesiology","subtitle":"EJA"}],"physDesc":[{"extent":"Online-Ressource"}],"id":{"zdb":["2004964-X"],"doi":["10.1111/(ISSN)1365-2346"],"issn":["1365-2346"],"eki":["320441350"]},"recId":"320441350","name":{"displayForm":["publ. on behalf of the European Academy of Anaesthesiology and the European Society of Anaesthesiologists"]}}],"origin":[{"dateIssuedKey":"2023","dateIssuedDisp":"November 2023"}]} | ||
| SRT | |a BOESINGCHREFFECTSOFI2023 | ||