nach oben

Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Erschienen in:

18.01.2018 | Reports of Original Investigations

Effect of position and positive pressure ventilation on functional residual capacity in morbidly obese patients: a randomized trial

verfasst von: Etienne J. Couture, MD, FRCPC, Steeve Provencher, MD, MSc, FRCPC, Jacques Somma, B. Eng, MD, FRCPC, François Lellouche, MD, PhD, Simon Marceau, MD, FRCPC, Jean S. Bussières, MD, FRCPC

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 5/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose

In morbidly obese patients, the position and ventilation strategy used during pre-oxygenation influence the safe non-hypoxic apnea time and the functional residual capacity (FRC). In awake morbidly obese volunteers, we hypothesized that the FRC would be higher after a five-minute period of positive pressure ventilation compared with spontaneous ventilation at zero inspiratory pressure.

Methods

Using a prospective crossover randomized trial design, obese subjects underwent, in a randomized order, a combination of one of three positions, supine (S), beach chair (BC), and reverse Trendelenburg (RT), and one of two ventilation strategies, spontaneous ventilation at zero inspiratory pressure (ZEEP-SV) or with positive pressure (PP-SV) set to an inspiratory pressure of 8 cmH₂O, positive end-expiratory pressure of 10 cmH₂O, and fraction of inspired oxygen of 0.21.

Results

Seventeen obese volunteers with a mean (standard deviation; SD) body mass index of 50 (8) kg·m⁻² were included. Mean (SD) FRC in the three positions (S, BC, RT) was significantly higher using PP-SV compared with ZEEP-SV [2571 (477) vs 2215 (481) mL, respectively; mean difference, 356; 95% confidence interval (CI), 209 to 502; P < 0.001]. Mean (SD) FRC was significantly higher in the RT compared with BC position [2483 (521) vs 2338 (469) mL, respectively; mean difference, 145; 95% CI, 31 to 404; P = 0.01], while there was no difference between S and BC [2359 (519) mL vs 2338 (469) mL, respectively; mean difference, 21; 95% CI, -93 to 135; P = 0.89].

Conclusion

In awake morbidly obese volunteers, an increase in the FRC is observed when spontaneous ventilation at zero inspiratory pressure is switched to positive pressure. Compared with S positioning, the BC position had no measurable impact on the FRC. The RT position resulted in an optimal FRC.

Trial registration

clinicaltrials.gov (NCT02121808). Registered 24 April 2014.

Peterson GN, Domino KB, Caplan RA, Posner KL, Lee LA, Cheney FW. Management of the difficult airway: a closed claims analysis. Anesthesiology 2005; 103: 33-9.CrossRefPubMed

Cook TM, Woodall N, Frerk C, Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth 2011; 106: 617-31.CrossRefPubMed

Cook TM, Woodall N, Harper J, Benger J, Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesth 2011; 106: 632-42.CrossRefPubMed

Murphy C, Wong DT. Airway management and oxygenation in obese patients. Can J Anesth 2013; 60: 929-45.CrossRefPubMed

Jones RL, Nzekwu MM. The effects of body mass index on lung volumes. Chest 2006; 130: 827-33.CrossRefPubMed

Coussa M, Proietti S, Schnyder P, et al. Prevention of atelectasis formation during the induction of general anesthesia in morbidly obese patients. Anesth Analg 2004; 98: 1491-5.CrossRefPubMed

Nimmagadda U, Salem MR, Crystal GJ. Preoxygenation: physiologic basis, benefits, and potential risks. Anesth Analg 2017; 124: 507-17.CrossRefPubMed

Lundstrom LH, Moller AM, Rosenstock C, Astrup G, Wetterslev J. High body mass index is a weak predictor for difficult and failed tracheal intubation: a cohort study of 91,332 consecutive patients scheduled for direct laryngoscopy registered in the Danish Anesthesia Database. Anesthesiology 2009; 110: 266-74.PubMed

Farmery AD, Roe PG. A model to describe the rate of oxyhaemoglobin desaturation during apnoea. Br J Anaesth 1996; 76: 284-91.CrossRefPubMed

10.

Shah U, Wong J, Wong DT, Chung F. Preoxygenation and intraoperative ventilation strategies in obese patients: a comprehensive review. Curr Opin Anaesthesiol 2016; 29: 109-18.CrossRefPubMed

11.

Dixon BJ, Dixon JB, Carden JR, et al. Preoxygenation is more effective in the 25 degrees head-up position than in the supine position in severely obese patients: a randomized controlled study. Anesthesiology 2005; 102: 1110-5; discussion 5A.

12.

Valenza F, Vagginelli F, Tiby A, et al. Effects of the beach chair position, positive end-expiratory pressure, and pneumoperitoneum on respiratory function in morbidly obese patients during anesthesia and paralysis. Anesthesiology 2007; 107: 725-32.CrossRefPubMed

13.

Futier E, Constantin JM, Pelosi P, et al. Noninvasive ventilation and alveolar recruitment maneuver improve respiratory function during and after intubation of morbidly obese patients: a randomized controlled study. Anesthesiology 2011; 114: 1354-63.CrossRefPubMed

14.

Collins JS, Lemmens HJ, Brodsky JB, Brock-Utne JG, Levitan RM. Laryngoscopy and morbid obesity: a comparison of the “sniff” and “ramped” positions. Obes Surg 2004; 49: 1171-5.CrossRef

15.

Wanger J, Clausen JL, Coates A, et al. Standardisation of the measurement of lung volumes. Eur Respir J 2005; 26: 511-22.CrossRefPubMed

16.

Gander S, Frascarolo P, Suter M, Spahn DR, Magnusson L. Positive end-expiratory pressure during induction of general anesthesia increases duration of nonhypoxic apnea in morbidly obese patients. Anesth Analg 2005; 100: 580-4.CrossRefPubMed

17.

Porhomayon J, Papadakos P, Singh A, Nader ND. Alteration in respiratory physiology in obesity for anesthesia-critical care physician. HSR Proc Intensive Care Cardiovasc Anesth 2011; 3: 109-18.PubMedPubMedCentral

18.

Benedik PS, Baun MM, Keus L, et al. Effects of body position on resting lung volume in overweight and mildly to moderately obese subjects. Respir Care 2009; 54: 334-9.PubMed

19.

Koenig SM. Pulmonary complications of obesity. Am J Med Sci 2001; 321: 249-79.CrossRefPubMed

20.

Pelosi P, Croci M, Ravagnan I, Vicardi P, Gattinoni L. Total respiratory system, lung, and chest wall mechanics in sedated-paralyzed postoperative morbidly obese patients. Chest 1996; 109: 144-51.CrossRefPubMed

21.

Cressey DM, Berthoud MC, Reilly CS. Effectiveness of continuous positive airway pressure to enhance pre-oxygenation in morbidly obese women. Anaesthesia 2001; 56: 680-4.CrossRefPubMed

22.

Delay JM, Sebbane M, Jung B, et al. The effectiveness of noninvasive positive pressure ventilation to enhance preoxygenation in morbidly obese patients: a randomized controlled study. Anesth Analg 2008; 107: 1707-13.CrossRefPubMed

23.

Tanoubi I, Drolet P, Fortier LP, Donati F. Inspiratory support versus spontaneous breathing during preoxygenation in healthy subjects. A randomized, double blind, cross-over trial. Ann Fr Anesth Reanim 2010; 29: 198-203.CrossRefPubMed

24.

Georgescu M, Tanoubi I, Fortier LP, Donati F, Drolet P. Efficacy of preoxygenation with non-invasive low positive pressure ventilation in obese patients: crossover physiological study (French). Ann Fr Anesth Reanim 2012; 31: e161-5.CrossRefPubMed

25.

Watson RA, Pride NB. Postural changes in lung volumes and respiratory resistance in subjects with obesity. J Appl Physiol 1985; 2005(98): 512-7.

26.

Craig DB, Wahba WM, Don HF, Couture JG, Becklake MR. “Closing volume” and its relationship to gas exchange in seated and supine positions. J Appl Physiol 1971; 31: 717-21.CrossRefPubMed

27.

Hignett R, Fernando R, McGlennan A, et al. A randomized crossover study to determine the effect of a 30° head-up versus a supine position on the functional residual capacity of term parturients. Anesth Analg 2011; 113: 1098-102.CrossRefPubMed

28.

Lee BJ, Kang JM, Kim DO. Laryngeal exposure during laryngoscopy is better in the 25° back-up position than in the supine position. Br J Anaesth 2007; 99: 581-6.CrossRefPubMed

29.

Campbell IT, Beatty PC. Monitoring preoxygenation. Br J Anaesth 1994; 72: 3-4.CrossRefPubMed

30.

Baraka AS, Hanna MT, Jabbour SI, et al. Preoxygenation of pregnant and nonpregnant women in the head-up versus supine position. Anesth Analg 1992; 75: 757-9.CrossRefPubMed

31.

Boyce JR, Ness T, Castroman P, Gleysteen JJ. A preliminary study of the optimal anesthesia positioning for the morbidly obese patient. Obes Surg 2003; 13: 4-9.CrossRefPubMed

32.

Anonymous. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. National Institutes of Health. Obes Res 1998; 6 Suppl 2: 51S-209S.

Titel: Effect of position and positive pressure ventilation on functional residual capacity in morbidly obese patients: a randomized trial
verfasst von: Etienne J. Couture, MD, FRCPC
Steeve Provencher, MD, MSc, FRCPC
Jacques Somma, B. Eng, MD, FRCPC
François Lellouche, MD, PhD
Simon Marceau, MD, FRCPC
Jean S. Bussières, MD, FRCPC
Publikationsdatum: 18.01.2018
Verlag: Springer US
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 5/2018
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-018-1050-1

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

Effect of position and positive pressure ventilation on functional residual capacity in morbidly obese patients: a randomized trial