Effect of three different levels and patterns of positive endexpiratory pressure on arterial oxygenation of obese patients under general anesthesia in beach-chair position

Faculty Medicine Year: 2021
Type of Publication: ZU Hosted Pages:
Authors:
Salwa Hassan Mohamed Wally
Journal: Research and Opinion in Anesthesia & Intensive Care Research and Opinion in Anesthesia & Intensive Care Volume:
Keywords : Effect , three different levels , patterns , positive    
Abstract:
ackground Obese patients are increasing among surgical population. Aim To detect the most beneficial level and pattern of positive end-expiratory pressure (PEEP) to mechanically ventilate obese patients under general anesthesia in beach-chair position. Patients and methods A prospective randomized study was conducted that included 45 ASA II patients (21–65 years) of both sexes who were randomized into three groups: group I (n=15), ascending PEEP (5, 7, 10 cmH2O); group II (n=15), steady PEEP5; and group III (n=15), descending PEEP (10, 7, 5 cmH2O). Results Arterial oxygenation (PaO2/FiO2) was significantly higher in group III at PEEP10 (470±10) than groups I (418±19) and II (422±12) at that time. At PEEP10, PaO2/ FiO2 was significantly higher in group III (470±10) than group I (448±11). After 40 min, it was significantly higher in group III (456±66) than groups I (432±12) and II (428±14). After 60 min, it was significantly lower at group II (426±12) than groups I (448±11) and III (444±24). Postoperatively, it was significantly higher in group III (460±24) than group I (436±11) and II (415±61). Peak airway pressure was significantly higher with PEEP10 in group I (34.6±2.2) than groups II (26.5±3.8) and III (27.7±3.2). It was also significantly higher with PEEP10 in group III (34.1±2.1) than groups I (26.7±3.7) and II (27.3±3.8). Plateau pressure was significantly higher with PEEP10 in group I (23.8±2.1) than groups II (15.1±3) and III (15.2±2.6). It was also significantly higher with PEEP10 in group III (23.3±1.7) than groups I (15.3±2.9) and II (15.9±2.6). Driving pressure was significantly higher in group III (13.3±1.7) than groups I (10.3±2.9) and II (10.9 ±2.6) with PEEP10. It was also significantly higher in group I with PEEP10 (13.8±2.1) than groups II (10.1±3) and III (10.2±2.6). Conclusion Descending pattern of PEEP (10, 7, and 5) improves oxygenation more effectively than ascending pattern of PEEP (5, 7, and 10) or steady pattern (PEEP5) for mechanical ventilation of obese patients under general anesthesia in beach-chair position. Keywords: driving pressure, mechanical ventilation, obesity, positive end-expiratory pressure
    
     
 
       

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