Prevention of Atelectasis in Morbidly Obese Patients during General Anesthesia and Paralysis: A Computerized Tomography Study

@article{Reinius2009PreventionOA,
  title={Prevention of Atelectasis in Morbidly Obese Patients during General Anesthesia and Paralysis: A Computerized Tomography Study},
  author={Henrik Reinius and L. Jonsson and Sven A Gustafsson and Magnus Sundbom and Olov Duvernoy and Paolo Pelosi and G{\"o}ran Hedenstierna and Filip Freden},
  journal={Anesthesiology},
  year={2009},
  volume={111},
  pages={979-987}
}
Background:Morbidly obese patients show impaired pulmonary function during anesthesia and paralysis, partly due to formation of atelectasis. This study analyzed the effect of general anesthesia and three different ventilatory strategies to reduce the amount of atelectasis and improve respiratory function. Methods:Thirty patients (body mass index 45 ± 4 kg/m2) scheduled for gastric bypass surgery were prospectively randomized into three groups: (1) positive end-expiratory pressure of 10 cm H2O… 
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299 Citations
Highly Influential Citations
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Background Citations
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Methods Citations
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299 Citations

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Assessment of Ventilation Distribution during Laparoscopic Bariatric Surgery: An Electrical Impedance Tomography Study
TLDR
In the obese patients PEEP level of 10 cm H2O preceded by a recruitment maneuver improves respiratory compliance and oxygenation but does not eliminate atelectasis induced by general anaesthesia.
The Effect of Positive End Expiratory Pressure (PEEP) with Recruitment Maneuvers on Atelectasis in Obese Patients Undergoing Abdominal Surgery: A Systematic Review
TLDR
The use of PEEP with alveolar recruitment maneuvers should be employed for obese patients that undergo abdominal surgery with general anesthesia to recruit and restore atelectatic lung tissue and prevent further formation of atelectasis.
The Influences of three Intraoperative Ventilatory Strategies on Arterial Oxygenation in Morbid Obese Patients Undergoing Laparoscopic Bariatric Surgery
TLDR
RM and IRV had provided better arterial oxygenation and respiratory mechanics compared to conventional ventilation in morbid obese patients undergoing laparoscopic bariatric surgery, however, RM had better gas exchange than IRV.
The effect of lung recruitment maneuvers on post-operative pulmonary complications for patients undergoing general anesthesia: A meta-analysis
TLDR
According to the findings from contemporary meta-analysis, LRMs combining with lung protective ventilation strategy may have an association with decreasing in the incidence of PPCs and improvement of oxygenation on non-obese patients.
Inspiratory Oxygen Fraction and Postoperative Complications in Obese Patients: A Subgroup Analysis of the PROXI Trial
TLDR
Administration of 80% oxygen compared with 30% oxygen did not reduce the frequency of SSI in obese patients, and no significant association was found between oxygen fraction and the risk of pulmonary complications.
Perioperative Pulmonary Atelectasis: Part II. Clinical Implications.
TLDR
Preoperative interventions may open new opportunities to minimize perioperative lung collapse and prevent pulmonary complications, and knowledge of pathophysiologic mechanisms of atelectasis and their consequences in the healthy and diseased lung should provide the basis for current practice.
Mechanisms of atelectasis in the perioperative period.
Noninvasive Ventilation and Alveolar Recruitment Maneuver Improve Respiratory Function during and after Intubation of Morbidly Obese Patients: A Randomized Controlled Study
TLDR
NPPV improves oxygenation and EELV in morbidly obese patients compared with conventional preoxygenation and early RM combined with early RM is more effective than NPPV alone at improving respiratory function after ETI.
Individualized positive end-expiratory pressure in obese patients during general anaesthesia: a randomized controlled clinical trial using electrical impedance tomography
TLDR
In obese patients, an RM and higher PEEP IND restored EELV, regional ventilation distribution, and oxygenation during anaesthesia, but these differences did not persist after extubation, therefore, lung protection strategies should include the postoperative period.
Individualized versus Fixed Positive End-expiratory Pressure for Intraoperative Mechanical Ventilation in Obese Patients: A Secondary Analysis
TLDR
This secondary analysis of obese patients undergoing laparoscopic surgery found better oxygenation, lower driving pressures, and redistribution of ventilation toward dependent lung areas measured by electrical impedance tomography using individualized PEEP.
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