Expiratory flow limitation in morbidly obese postoperative mechanically ventilated patients

Acta Anaesthesiologica Scandinavica
A KoutsoukouC Roussos

Abstract

Although obesity promotes tidal expiratory flow limitation (EFL), with concurrent dynamic hyperinflation (DH), intrinsic PEEP (PEEPi) and risk of low lung volume injury, the prevalence and magnitude of EFL, DH and PEEPi have not yet been studied in mechanically ventilated morbidly obese subjects. In 15 postoperative mechanically ventilated morbidly obese subjects, we assessed the prevalence of EFL [using the negative expiratory pressure (NEP) technique], PEEPi, DH, respiratory mechanics, arterial oxygenation and PEEPi inequality index as well as the levels of PEEP required to abolish EFL. In supine position at zero PEEP, 10 patients exhibited EFL with a significantly higher PEEPi and DH and a significantly lower PEEPi inequality index than found in the five non-EFL (NEFL) subjects. Impaired gas exchange was found in all cases without significant differences between the EFL and NEFL subjects. Application of 7.5 +/- 2.5 cm H2O of PEEP (range: 4-16) abolished EFL with a reduction of PEEPi and DH and an increase in FRC and the PEEPi inequality index but no significant effect on gas exchange. The present study indicates that: (a) on zero PEEP, EFL is present in most postoperative mechanically ventilated morbidly obese subjects; (b) ...Continue Reading

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Citations

Oct 21, 2006·Intensive Care Medicine·Antonia KoutsoukouCharis Roussos
Jan 24, 2007·European Journal of Applied Physiology·Joseph Milic-EmiliEdgardo D'Angelo
Mar 9, 2012·Anesthesiology Research and Practice·Javier H Campos, Kenichi Ueda
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Dec 21, 2004·Intensive Care Medicine·Antonia Koutsoukou
May 5, 2011·Chest·Babak MokhlesiSairam Parthasarathy
Apr 22, 2016·Hospital Practice·Bernardo J SelimSalim Surani
Feb 9, 2016·World Journal of Critical Care Medicine·Antonia KoutsoukouNikoletta Rovina
Feb 22, 2018·American Journal of Respiratory and Critical Care Medicine·Hodane YonisClaude Guérin
Mar 29, 2019·Expert Review of Respiratory Medicine·Giulia BonattiPaolo Pelosi
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Aug 19, 2016·Anesthesia and Analgesia·Savino SpadaroCarlo Alberto Volta
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Jan 31, 2019·World Journal of Critical Care Medicine·Antonia Koutsoukou, Matteo Pecchiari
Dec 7, 2019·Critical Care : the Official Journal of the Critical Care Forum·Carlo Alberto VoltaSavino Spadaro
Aug 19, 2021·Journal of Cardiothoracic and Vascular Anesthesia·Lorenzo BallElena Bignami
Aug 9, 2021·Chest·Michaela R Anderson, Michael G S Shashaty

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