Gerardo Tusman, Matías Nicolás, Alejandro Carmona, Fernando Suarez Sipmann, Ulises Tusman, Peter Kremeier, Stephan H Böhm
{"title":"术中以压力为基础的血管造影选择PEEP:一项概念验证研究。","authors":"Gerardo Tusman, Matías Nicolás, Alejandro Carmona, Fernando Suarez Sipmann, Ulises Tusman, Peter Kremeier, Stephan H Böhm","doi":"10.1007/s10877-025-01318-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to test a new method to determine the positive-end expiratory pressure (PEEP) that maintains the lungs open after a recruitment maneuver (RM).</p><p><strong>Methods: </strong>In eleven anesthetized patients, we compared the standard RM searching for the optimal PEEP based on the highest respiratory compliance (PEEP<sub>Crs</sub>), with a new method. This method performs a RM during a slow pressure-volume curve and detects the optimal PEEP using the novel barometric capnography curve (BCap); i.e. the plot of expired carbon dioxide versus airway pressure. The lungs' closing pressure was detected when the slope of phase III of the BCap changed along this slow expiration (PEEP<sub>BCap</sub>). The main objective was to compare PEEP<sub>BCap</sub> with the reference PEEP<sub>Crs</sub>. As a secondary objective, we explored the association between PEEP<sub>BCap</sub> and the polarity change in end-expiratory transpulmonary pressure (PEEP<sub>PL</sub>) during the deflation phase of a slow flow PV curve.</p><p><strong>Results: </strong>We found a PEEP<sub>BCap</sub> of 8.5(3.3) cmH<sub>2</sub>O that was no statistically different from the PEEP<sub>Crs</sub> of 10.0(4.0) cmH<sub>2</sub>O (p = 0.72). Both methods correlated well with a Rho of 0.84 (p < 0.001). The Bland-Altman plot showed a bias of 0.19 and LOA of 1.92 cmH<sub>2</sub>O (95%CI -0.39 to 0.77 cmH<sub>2</sub>O). During the PV slow deflation limb, PEEP<sub>PL</sub> was 9.3(4.3), which was statistically similar to PEEP<sub>BCap</sub> (p = 0.61). Both pressures were strongly correlated (Rho = 0.93, p < 0.001) with a bias of -0.3 cmH<sub>2</sub>O and LOA of 1.52 (95%CI -0.76 to 0.16 cmH<sub>2</sub>O).</p><p><strong>Conclusions: </strong>We concluded that BCap is feasible to detect lungs collapse using a constant flow PV curve.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Intraoperative PEEP selection by pressure-based capnography: a proof of concept study.\",\"authors\":\"Gerardo Tusman, Matías Nicolás, Alejandro Carmona, Fernando Suarez Sipmann, Ulises Tusman, Peter Kremeier, Stephan H Böhm\",\"doi\":\"10.1007/s10877-025-01318-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>We aimed to test a new method to determine the positive-end expiratory pressure (PEEP) that maintains the lungs open after a recruitment maneuver (RM).</p><p><strong>Methods: </strong>In eleven anesthetized patients, we compared the standard RM searching for the optimal PEEP based on the highest respiratory compliance (PEEP<sub>Crs</sub>), with a new method. This method performs a RM during a slow pressure-volume curve and detects the optimal PEEP using the novel barometric capnography curve (BCap); i.e. the plot of expired carbon dioxide versus airway pressure. The lungs' closing pressure was detected when the slope of phase III of the BCap changed along this slow expiration (PEEP<sub>BCap</sub>). The main objective was to compare PEEP<sub>BCap</sub> with the reference PEEP<sub>Crs</sub>. As a secondary objective, we explored the association between PEEP<sub>BCap</sub> and the polarity change in end-expiratory transpulmonary pressure (PEEP<sub>PL</sub>) during the deflation phase of a slow flow PV curve.</p><p><strong>Results: </strong>We found a PEEP<sub>BCap</sub> of 8.5(3.3) cmH<sub>2</sub>O that was no statistically different from the PEEP<sub>Crs</sub> of 10.0(4.0) cmH<sub>2</sub>O (p = 0.72). Both methods correlated well with a Rho of 0.84 (p < 0.001). The Bland-Altman plot showed a bias of 0.19 and LOA of 1.92 cmH<sub>2</sub>O (95%CI -0.39 to 0.77 cmH<sub>2</sub>O). During the PV slow deflation limb, PEEP<sub>PL</sub> was 9.3(4.3), which was statistically similar to PEEP<sub>BCap</sub> (p = 0.61). Both pressures were strongly correlated (Rho = 0.93, p < 0.001) with a bias of -0.3 cmH<sub>2</sub>O and LOA of 1.52 (95%CI -0.76 to 0.16 cmH<sub>2</sub>O).</p><p><strong>Conclusions: </strong>We concluded that BCap is feasible to detect lungs collapse using a constant flow PV curve.</p>\",\"PeriodicalId\":15513,\"journal\":{\"name\":\"Journal of Clinical Monitoring and Computing\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-06-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Monitoring and Computing\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10877-025-01318-7\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Monitoring and Computing","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10877-025-01318-7","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Intraoperative PEEP selection by pressure-based capnography: a proof of concept study.
Purpose: We aimed to test a new method to determine the positive-end expiratory pressure (PEEP) that maintains the lungs open after a recruitment maneuver (RM).
Methods: In eleven anesthetized patients, we compared the standard RM searching for the optimal PEEP based on the highest respiratory compliance (PEEPCrs), with a new method. This method performs a RM during a slow pressure-volume curve and detects the optimal PEEP using the novel barometric capnography curve (BCap); i.e. the plot of expired carbon dioxide versus airway pressure. The lungs' closing pressure was detected when the slope of phase III of the BCap changed along this slow expiration (PEEPBCap). The main objective was to compare PEEPBCap with the reference PEEPCrs. As a secondary objective, we explored the association between PEEPBCap and the polarity change in end-expiratory transpulmonary pressure (PEEPPL) during the deflation phase of a slow flow PV curve.
Results: We found a PEEPBCap of 8.5(3.3) cmH2O that was no statistically different from the PEEPCrs of 10.0(4.0) cmH2O (p = 0.72). Both methods correlated well with a Rho of 0.84 (p < 0.001). The Bland-Altman plot showed a bias of 0.19 and LOA of 1.92 cmH2O (95%CI -0.39 to 0.77 cmH2O). During the PV slow deflation limb, PEEPPL was 9.3(4.3), which was statistically similar to PEEPBCap (p = 0.61). Both pressures were strongly correlated (Rho = 0.93, p < 0.001) with a bias of -0.3 cmH2O and LOA of 1.52 (95%CI -0.76 to 0.16 cmH2O).
Conclusions: We concluded that BCap is feasible to detect lungs collapse using a constant flow PV curve.
期刊介绍:
The Journal of Clinical Monitoring and Computing is a clinical journal publishing papers related to technology in the fields of anaesthesia, intensive care medicine, emergency medicine, and peri-operative medicine.
The journal has links with numerous specialist societies, including editorial board representatives from the European Society for Computing and Technology in Anaesthesia and Intensive Care (ESCTAIC), the Society for Technology in Anesthesia (STA), the Society for Complex Acute Illness (SCAI) and the NAVAt (NAVigating towards your Anaestheisa Targets) group.
The journal publishes original papers, narrative and systematic reviews, technological notes, letters to the editor, editorial or commentary papers, and policy statements or guidelines from national or international societies. The journal encourages debate on published papers and technology, including letters commenting on previous publications or technological concerns. The journal occasionally publishes special issues with technological or clinical themes, or reports and abstracts from scientificmeetings. Special issues proposals should be sent to the Editor-in-Chief. Specific details of types of papers, and the clinical and technological content of papers considered within scope can be found in instructions for authors.