Efficacy and Safety of Lung Recruitment Maneuver in Patients with different Peripheral Chemoreflex Sensitivity
Trembach, N.V.; Zabolotskikh, I.B.
Anesteziologiia i Reanimatologiia 60(6): 8-11
2015
ISSN/ISBN: 0201-7563 PMID: 27025125 Document Number: 681762
The concept of open lungs, which includes a maintaining of positive end-expiratory pressure (PEEP) and lung recruitment maneuver (LRM), proven in the prevention of atelectasis occurring during anesthesia with mechanical ventilation (MV). However, it adversely affects the central hemodynamics, and can increase the incidence of perioperative complications, especially in elderly patients. The sensitivity of the peripheral chemoreflex (SPCR) is a marker of disturbed neuroreflex regulation of the cardiorespiratory system. The aim of the study was to evaluate the influence of LRM on the cardiorespiratory system in patients with different SPCR. Methods: The study was conducted in 85 elderly patients which were undergone abdominal surgery under general anesthesia and mechanical ventilation with LRM and the subsequent maintenance of PEEP The patients were divided into two groups, according to the SPCR level determined using Shtange test: Group B had a high SPCR (n = 35); Group C--the middle SPCR (n = 50). The respiratory system compliance and arterial blood oxygenation were increased and airway resistance was decreased in both groups. LRM led to a decrease in cardiac index in both groups, but in the group C this decrease was offset by an increase in peripheral vascular resistance, which did not occur in Group B. The observed changes in Group B have caused a more frequent hypotension, use ofvasopressors and infusion. LRM improves oxygenation and biomechanical properties of the respiratory system. In patients with impaired reflex regulation of the cardiorespiratory system LRM increases the risk of hemodynamic disturbances.