Abstract
General anesthesia is associated with impaired gas exchange mainly because of increased shunt due to atelectasis in the dependent regions of the lung. Postoperative atelectasis is associated with adverse clinical outcomes in terms of hypoxic respiratory failure requiring endotracheal intubation and pneumonia secondary to impairment of ciliary and lymphatic functions. Prevention of atelectasis and/or airway closure could be a mechanism by which positive end expiratory pressure (PEEP) improves oxygenation. Positive end expiratory pressure has been used intraoperatively as a part of open lung and protective lung ventilation strategies. However, it is unclear at the present time whether the intraoperative use of PEEP is associated with a decrease in mortality or in the incidence of other important clinical surrogates of outcome such as postoperative respiratory failure. The aim of this review is to review the physiologic effects and history of PEEP, to present some of the current uses in specific surgical populations and comment on potential benefits on postoperative mortality and pulmonary complications that may be ascribed to intraoperative PEEP use.
Highlights
Positive end expiratory pressure (PEEP) is a mechanical ventilatory maneuver of exerting a supra-atmospheric pressure in the lungs at end exhalation
It is important to recognize that PEEP is not a ventilator mode by itself; rather it is an adjunctive treatment that can be applied to all forms of mechanical ventilation; controlled, assisted or spontaneous [1]
There were no significant differences in mortality, incidence of barotrauma or adverse cardiac events between the 2 groups
Summary
Positive end expiratory pressure (PEEP) is a mechanical ventilatory maneuver of exerting a supra-atmospheric pressure in the lungs at end exhalation. Creation of a positive pressure at end exhalation increases the functional residual capacity (FRC) of the lungs by decreasing the collapse of the small airways reducing atelectasis [2]. Positive end expiratory pressure-induced decrease in renal and splanchnic circulations are related to its effects on cardiac output and the level of the PEEP applied as well as the volume status of the individual. Alveolar collapse is exaggerated by age when the closing volume exceeds the expiratory reserve volume in the supine position at age of 50 [36] This is the main mechanism by which atelectasis occurs in patients with ARDS. Serum IL-10 decreased more rapidly in the early OLV group
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