Abstract
After intubation for elective upper abdominal surgery 30 patients were randomized in group A or B. Both groups had the same anaesthetics and were ventilated with a tidal volume of 12 ml/kg the rate keeping PaCO2 near 40 mm Hg. Group A was ventilated with ZEEP and group B with PEEP 10 cm H2O. Group A was extubated when VC reached 15 ml/kg and PaCO2 did not exceed 50 mm Hg breathing spontaneously. Group B was allowed to breathe spontaneously with CPAP and PEEP 5 cm H2O (Basel PEEP-WeanerR) for 3 hours before extubation. Measurements: BP, PAP, RAP, HR, Hb, arterial and mixed-venous blood gases with FIO2=0,21. Both groups were similar in age, sex, cigarette consumption, preoperative pulmonary pathology, surgical procedure pathology, surgical procedure and time of operation.
Results: RAP, PAP, BP, HR, PaCO2, PaH, Pv−O2 did not show important differences. Mean PaO2 changed as follows:
Postoperative chest X-rays showed in Group A a total of 56 negative scores, in Group B 25.
Conclusion: After upper abdominal surgery the well known decrease of FRC with its increased venous admixture can be prevented if the patient is ventilated with PEEP during operation and is breathing spontaneously with CPAP and PEEP for 3 postoperative hours before extubation.
Similar content being viewed by others
References
Marshall, B.E., Wyche, M.Q.: Hypoxemia during and after anesthesia. Anesthesiology37, 178 (1972)
Kitamura, H., Sawa, T., Ikezono, E.: Postoperative hypoxemia: the contribution of age to the maldistribution of ventilation. Anesthesiology36, 244 (1972)
Laws, A.K.: Effects of induction of anesthesia and muscle paralysis on functional residual capacity of the lungs. Can. Anaesth. Soc. J.15, 325 (1968)
Cottrell, J.E., Siker, E.S.: Postoperative intermittent positive pressure breathing therapy in patients with chronic obstructive lung disease: effect on postoperative pulmonary complications. Anesth. Analg.52, 258 (1973)
Boutros, A.R., Weisel, M.: Comparison of effects of three anaesthetic techniques on patients with severe pulmonary obstructive disease. Can. Anaesth. Soc. J.18, 286 (1971)
Fairley, H.B., Kerr, J.H., Laws, A.K., et al.: The avoidance of postoperative hypoxaemia: an assessment of three techniques for use during anaesthesia. Can. Anaesth. Soc. J.15, 152 (1968)
Ashbaugh, D.G., Petty, T.L.: Positive end-expiratory pressure. J. Thorac. Cardiovasc. Surg.65, 165 (1973)
Wyche, M.Q., Teichner, R.L., Kallos, T., et al.: Effects of continuous positive pressure breathing on functional residual capacity and arterial oxygenation during intraabdominal operations: studies in man during nitrous oxide and d-tubocurarine anesthesia. Anesthesiology38, 68 (1973)
Patton, C.M., Jr., Dannemiller, F.J., Broennle, A.M.: CPPB during surgical anesthesia: effect on oxygenation and blood pressure. Anesth. Analg.53, 309 (1974)
Yakaitis, R.W., Thomas, J.D., Mahaffey, J.E.: Effects of intraoperative PEEP on postoperative arterial oxygenation. Anesth. Analg.54, 427 (1975)
Dittmann, M., Lehmann, K., Pochon, J.P., Wolff, G.: Neue Technik der Spontanatmung mit positiv endexspiratorischem Druck (PEEP) beim Erwachsenen. Intensivmed.14, 101 (1977)
Dittmann, M., Pike, P.M.H., Wolff, G.: The Basle PEEP weaner. A versatile device for respiratory assistance. Anaesthesia32, 559 (1977)
Wolff, G., Grädel, E., Gasser, D.: Die künstliche Beatmung auf Intensivstationen. Berlin, Heidelberg, New York: Springer 1977
Ruiz, B.C., Tucker, W.K., Kirby, R.R.: A program for calculation of intrapulmonary shunts, blood-gas and acid-base values with a programmable calculator. Anesthesiology42, 88 (1975)
Author information
Authors and Affiliations
Additional information
Deceased 1976
Rights and permissions
About this article
Cite this article
Anderes, C., Anderes, U., Gasser, D. et al. Postoperative spontaneous breathing with CPAP to normalize late postoperative oxygenation. Intensive Care Med 5, 15–21 (1979). https://doi.org/10.1007/BF01738997
Issue Date:
DOI: https://doi.org/10.1007/BF01738997