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Effects of positive end-expiratory pressure alone or an open-lung approach on recruited lung volumes and respiratory mechanics of mechanically ventilated horses

  • Joaquin D. Araos
    Affiliations
    Centre Hospitalier Universitaire Veterinaire, Faculte de Medecine Veterinaire, Universite de Montreal, Québec, Canada
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  • Luca Lacitignola
    Affiliations
    Surgery Unit, Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation D.E.O.T., “Aldo Moro” University of Bari, Bari, Italy
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  • Tania Stripoli
    Affiliations
    Section of Anesthesia and Intensive Care, Department of Emergency and Organ Transplantation (D.E.O.T.), “Aldo Moro” University of Bari, Bari, Italy
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  • Salvatore Grasso
    Affiliations
    Section of Anesthesia and Intensive Care, Department of Emergency and Organ Transplantation (D.E.O.T.), “Aldo Moro” University of Bari, Bari, Italy
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  • Antonio Crovace
    Affiliations
    Surgery Unit, Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation D.E.O.T., “Aldo Moro” University of Bari, Bari, Italy
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  • Francesco Staffieri
    Correspondence
    Correspondence: Francesco Staffieri, Department of Emergency and Organ Transplantation, University of Bari, SP 62 per Casamassima km 3, 70010 Valenzano (Bari), Italy.
    Affiliations
    Surgery Unit, Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation D.E.O.T., “Aldo Moro” University of Bari, Bari, Italy
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      Abstract

      Objective

      To evaluate the effects of positive end-expiratory pressure (PEEP) alone and PEEP preceded by lung recruitment manoeuvre (LRM) on lung volumes and respiratory system mechanics in healthy horses undergoing general anaesthesia.

      Study design

      Controlled, prospective clinical study.

      Animals

      A group of 15 horses undergoing arthroscopy.

      Methods

      Following anaesthetic induction, initial ventilatory settings were: tidal volume 15 mL kg–1, inspiratory:expiratory ratio 1:2, respiratory rate to maintain end-tidal CO2 between 5.3–6.6 kPa (40–50 mmHg). The following settings were implemented sequentially: zero PEEP (ZEEP); PEEP 10 cmH2O (PEEP); LRM (50 cmH2O for 20 seconds) followed by 10 cmH2O of PEEP (LRM + PEEP). Static compliance (Cst), driving pressure, delta end-expiratory (ΔEELV) and recruited lung volumes (RLV) were obtained 30 minutes after initiating each ventilatory strategy. Data were analyzed with paired t test or analysis of variance followed by Tukey’s post hoc test. Data are shown as mean ± standard deviation; p < 0.05 was considered significant.

      Results

      PEEP induced ΔEELV of 6.68 ± 3.36 mL kg–1; ΔEELV during LRM + PEEP was 14.28 ± 5.59 mL kg–1 (p < 0.0001). The RLV was greater during the LRM + PEEP phase (12.30 ± 5.85 mL kg–1) than during PEEP (4.47 ± 3.97 mL kg–1; p < 0.0001). The Cst was unchanged from ZEEP to PEEP (0.75 ± 0.21 and 0.85 ± 0.22 mL cmH2O−1 kg–1, respectively, p = 0.36) but increased using LRM + PEEP (1.11 ± 0.25 mL cmH2O−1 kg–1, p = 0.0004). Driving pressure was lower during LRM + PEEP than during PEEP and ZEEP (16 ± 2, 19 ± 2 and 21 ± 4 cmH2O, respectively, p < 0.0001).

      Conclusions and clinical relevance

      Unlike PEEP alone, PEEP preceded by LRM increased RLV and Cst and reduced driving pressure in horses under anaesthesia.

      Keywords

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