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Effect of vital capacity manoeuvres on arterial oxygenation in morbidly obese patients undergoing open bariatric surgery

Published online by Cambridge University Press:  01 March 2007

V. Chalhoub ,
A. Yazigi ,
G. Sleilaty ,
F. Haddad ,
R. Noun ,
S. Madi-Jebara  and
P. Yazbeck
V. Chalhoub
Affiliation:
Hotel Dieu de France Hospital, Department of Anaesthesia and Critical CareBeirut, Lebanon
A. Yazigi
Affiliation:
Hotel Dieu de France Hospital, Department of Anaesthesia and Critical CareBeirut, Lebanon
G. Sleilaty
Affiliation:
Hotel Dieu de France Hospital, Department of Anaesthesia and Critical CareBeirut, Lebanon
F. Haddad
Affiliation:
Hotel Dieu de France Hospital, Department of Anaesthesia and Critical CareBeirut, Lebanon
R. Noun
Affiliation:
Hotel Dieu de France Hospital, Department of General Surgery, Beirut, Lebanon
S. Madi-Jebara
Affiliation:
Hotel Dieu de France Hospital, Department of Anaesthesia and Critical CareBeirut, Lebanon
P. Yazbeck
Affiliation:
Hotel Dieu de France Hospital, Department of Anaesthesia and Critical CareBeirut, Lebanon
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Summary

Background

Arterial oxygenation may be compromised in morbidly obese patients undergoing bariatric surgery. The aim of this study was to evaluate the effect of a vital capacity manoeuvre (VCM), followed by ventilation with positive end-expiratory pressure (PEEP), on arterial oxygenation in morbidly obese patients undergoing open bariatric surgery.

Methods

Fifty-two morbidly obese patients (body mass index >40 kg m−2) undergoing open bariatric surgery were enrolled in this prospective and randomized study. Anaesthesia and surgical techniques were standardized. Patients were ventilated with a tidal volume of 10 mL kg−1 of ideal body weight, a mixture of oxygen and nitrous oxide (FiO2 = 40%) and respiratory rate was adjusted to maintain end-tidal carbon dioxide at a level of 30–35 mmHg. After abdominal opening, patients in Group 1 had a PEEP of 8 cm H2O applied and patients in Group 2 had a VCM followed by PEEP of 8 cm H2O. This manoeuvre was defined as lung inflation by a positive inspiratory pressure of 40 cm H2O maintained for 15 s. PEEP was maintained until extubation in the two groups. Haemodynamics, ventilatory and arterial oxygenation parameters were measured at the following times: T0 = before application of VCM and/or PEEP, T1 = 5 min after VCM and/or PEEP and T2 = before abdominal closure.

Results

Patients in the two groups were comparable regarding patient characteristics, surgical, haemodynamic and ventilatory parameters. In Group 1, arterial oxygen partial pressure (PaO2) and arterial haemoglobin oxygen saturation (SaO2) were significantly increased and alveolar-arterial oxygen pressure gradient (A-aDO2) decreased at T2 when compared with T0 and T1. In Group 2, PaO2 and SaO2 were significantly increased and A-aDO2 decreased at T1 and T2 when compared with T0. Arterial oxygenation parameters at T1 and T2 were significantly improved in Group 2 when compared with Group 1.

Conclusion

The addition of VCM to PEEP improves intraoperative arterial oxygenation in morbidly obese patients undergoing open bariatric surgery.

Keywords

SURGERY, abdominal, bariatricRESPIRATORY FUNCTION TESTS, gas exchangeMECHANICAL VENTILATIONMORBID OBESITYPOSITIVE PRESSURE RESPIRATION
Type
Research Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 3 , March 2007 , pp. 283 - 288
Copyright
Copyright © European Society of Anaesthesiology 2006

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