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Optimizing peroperative compliance with PEEP during upper abdominal surgery: effects on perioperative oxygenation and complications in patients without preoperative cardiopulmonary dysfunction

Published online by Cambridge University Press:  16 August 2006

J. Wetterslev
Affiliation:
Department of Anaesthesia and Intensive Care, Herlev University Hospital
E. G. Hansen
Affiliation:
Department of Anaesthesia and Intensive Care, Herlev University Hospital
O. Roikjaer
Affiliation:
Department of Abdominal Surgery, Herlev University Hospital
I. L. Kanstrup
Affiliation:
Department of Clinical Physiology, Herlev University Hospital
L. Heslet
Affiliation:
Department of Intensive Care, Rigshospitalet University Hospital, Denmark
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Abstract

Background and objective Late postoperative hypoxaemia after upper abdominal surgery is common even among cardiopulmonary healthy patients. Atelectasis may develop after intubation and persist into or reveal a disposition for atelectasis in the postoperative period. Positive end–expiratory pressure (PEEP) eliminates peroperative atelectasis but the effect on perioperative oxygenation is controversial. This study evaluated the effect of peroperative PEEP optimized pulmonary compliance on perioperative oxygenation and complications.

Methods Forty patients assessed by electrocardiography, spirometry, functional residual capacity and diffusion capacity were randomly assigned to receive positive end–expiratory pressure (PEEP) or zero endexpiratory pressure (ZEEP) during surgery. PaO2, SPO2 and complications in the postoperative period were evaluated without knowledge of peroperative PEEP or ZEEP application.

Results Peroperative arterial oxygenation improved for all patients receiving PEEP, mean 2.1 kPa (0.7–3.5 kPa). There was no difference in postoperative median PaO2 between the groups. The differences in the incidence of late prolonged postoperative hypoxaemia and complications were 25% (−5% to 55%) and −1% (−31% to 29%) between the ZEEP and the PEEP group, but were not statistically significant.

Type
Original Article
Copyright
2001 European Society of Anaesthesiology

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