Klaus Hopster, Joao Henrique Neves Soares, David Levine, Kyla Ortved, Bernd Driessen, Joaquin Araos
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Horses were randomly assigned to FLEX or VCV (volume-controlled ventilation) groups in dorsal (VCV-D and FLEX-D) or lateral recumbency (VCV-L and FLEX-L). Arterial blood gases were measured at 30, 75, and 120 min post-induction to assess arterial oxygenation (arterial partial pressure of oxygen to inspired fraction of oxygen ratio, PaO<sub>2</sub>/FiO<sub>2</sub>). A global index of ventilation/perfusion matching ([PaCO<sub>2</sub> - ETCO<sub>2</sub>]/PaCO<sub>2</sub>) was also calculated. Peak airway pressure (P<sub>peak</sub>) and tidal volume were measured to calculate dynamic respiratory system compliance (Cdyn). Data were compared with repeated-measures ANOVA.</p><p><strong>Results: </strong>Horses ventilated with FLEX showed significantly higher PaO<sub>2</sub>/FiO<sub>2</sub> (FLEX-D vs. VCV-D, 369 ± 42 vs. 198 ± 112 mmHg, p < 0.001; FLEX-L vs. VCV-L, 436 ± 38 vs. 249 ± 88 mmHg, p < 0.001). FLEX also improved Cdyn (FLEX-D vs. VCV-D, 0.81 ± 0.1 vs. 0.64 ± 0.12, p = 0.01) and the global V̇/Q̇ index ([PaCO<sub>2</sub> - ETCO<sub>2</sub>]/PaCO<sub>2</sub>) (FLEX-D vs. VCV-D, 0.11 ± 0.03 vs. 0.18 ± 0.03, p = 0.03) in dorsal-positioned but not lateral-positioned horses.</p><p><strong>Main limitations: </strong>Anaesthesia protocols were not standardised; anaesthetists were not masked to the intervention of interest, and findings may not be generalisable to other patient populations.</p><p><strong>Conclusions: </strong>These results confirm previous laboratory findings, demonstrating that FLEX improves oxygenation, ventilation-perfusion matching, and respiratory mechanics compared to VCV in a large clinical population of anaesthetised horses.</p>","PeriodicalId":11796,"journal":{"name":"Equine Veterinary Journal","volume":" ","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Flow-controlled expiration improves gas exchange in anaesthetised horses undergoing orthopaedic surgery.\",\"authors\":\"Klaus Hopster, Joao Henrique Neves Soares, David Levine, Kyla Ortved, Bernd Driessen, Joaquin Araos\",\"doi\":\"10.1111/evj.70079\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Flow-controlled expiration (FLEX) has been shown to significantly enhance oxygenation in horses under laboratory conditions.</p><p><strong>Objective: </strong>This study aims to corroborate these findings by evaluating the effects of FLEX on gas exchange in a randomised clinical trial involving a large population of clinical horses undergoing orthopaedic surgery.</p><p><strong>Study design: </strong>Prospective randomised clinical trial.</p><p><strong>Methods: </strong>A total of 406 healthy adult horses scheduled for elective orthopaedic procedures were recruited for this prospective clinical trial. Horses were randomly assigned to FLEX or VCV (volume-controlled ventilation) groups in dorsal (VCV-D and FLEX-D) or lateral recumbency (VCV-L and FLEX-L). Arterial blood gases were measured at 30, 75, and 120 min post-induction to assess arterial oxygenation (arterial partial pressure of oxygen to inspired fraction of oxygen ratio, PaO<sub>2</sub>/FiO<sub>2</sub>). A global index of ventilation/perfusion matching ([PaCO<sub>2</sub> - ETCO<sub>2</sub>]/PaCO<sub>2</sub>) was also calculated. Peak airway pressure (P<sub>peak</sub>) and tidal volume were measured to calculate dynamic respiratory system compliance (Cdyn). Data were compared with repeated-measures ANOVA.</p><p><strong>Results: </strong>Horses ventilated with FLEX showed significantly higher PaO<sub>2</sub>/FiO<sub>2</sub> (FLEX-D vs. VCV-D, 369 ± 42 vs. 198 ± 112 mmHg, p < 0.001; FLEX-L vs. VCV-L, 436 ± 38 vs. 249 ± 88 mmHg, p < 0.001). 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引用次数: 0
摘要
背景：流动控制呼气（FLEX）已被证明在实验室条件下显著增强马的氧合。目的：本研究旨在通过在一项随机临床试验中评估FLEX对气体交换的影响来证实这些发现，该试验涉及大量接受骨科手术的临床马匹。研究设计：前瞻性随机临床试验。方法：共招募406匹健康成年马进行选择性矫形手术，用于这项前瞻性临床试验。马被随机分配到仰卧（VCV- d和FLEX- d）或侧卧（VCV- l和FLEX- l）的FLEX或VCV（容积控制通气）组。在诱导后30,75和120min测量动脉血气以评估动脉氧合（动脉氧分压与吸入氧分数之比，PaO2/FiO2）。计算通气/灌注匹配全局指数（[PaCO2 - ETCO2]/PaCO2）。测量峰值气道压力（Ppeak）和潮气量，计算动态呼吸系统顺应性（Cdyn）。数据采用重复测量方差分析进行比较。结果：使用FLEX通气的马在背侧位的PaO2/FiO2 （FLEX- d vs. VCV-D, 369±42 vs. 198±112 mmHg, p 2 - ETCO2]/PaCO2）显著高于侧侧位的马（FLEX- d vs. VCV-D, 0.11±0.03 vs. 0.18±0.03,p = 0.03）。主要局限性：麻醉方案不规范；麻醉师并没有掩盖干预的兴趣，研究结果可能不能推广到其他患者群体。结论：这些结果证实了之前的实验室发现，表明在大量临床麻醉马匹中，与VCV相比，FLEX改善了氧合、通气-灌注匹配和呼吸力学。
Flow-controlled expiration improves gas exchange in anaesthetised horses undergoing orthopaedic surgery.
Background: Flow-controlled expiration (FLEX) has been shown to significantly enhance oxygenation in horses under laboratory conditions.
Objective: This study aims to corroborate these findings by evaluating the effects of FLEX on gas exchange in a randomised clinical trial involving a large population of clinical horses undergoing orthopaedic surgery.
Study design: Prospective randomised clinical trial.
Methods: A total of 406 healthy adult horses scheduled for elective orthopaedic procedures were recruited for this prospective clinical trial. Horses were randomly assigned to FLEX or VCV (volume-controlled ventilation) groups in dorsal (VCV-D and FLEX-D) or lateral recumbency (VCV-L and FLEX-L). Arterial blood gases were measured at 30, 75, and 120 min post-induction to assess arterial oxygenation (arterial partial pressure of oxygen to inspired fraction of oxygen ratio, PaO2/FiO2). A global index of ventilation/perfusion matching ([PaCO2 - ETCO2]/PaCO2) was also calculated. Peak airway pressure (Ppeak) and tidal volume were measured to calculate dynamic respiratory system compliance (Cdyn). Data were compared with repeated-measures ANOVA.
Results: Horses ventilated with FLEX showed significantly higher PaO2/FiO2 (FLEX-D vs. VCV-D, 369 ± 42 vs. 198 ± 112 mmHg, p < 0.001; FLEX-L vs. VCV-L, 436 ± 38 vs. 249 ± 88 mmHg, p < 0.001). FLEX also improved Cdyn (FLEX-D vs. VCV-D, 0.81 ± 0.1 vs. 0.64 ± 0.12, p = 0.01) and the global V̇/Q̇ index ([PaCO2 - ETCO2]/PaCO2) (FLEX-D vs. VCV-D, 0.11 ± 0.03 vs. 0.18 ± 0.03, p = 0.03) in dorsal-positioned but not lateral-positioned horses.
Main limitations: Anaesthesia protocols were not standardised; anaesthetists were not masked to the intervention of interest, and findings may not be generalisable to other patient populations.
Conclusions: These results confirm previous laboratory findings, demonstrating that FLEX improves oxygenation, ventilation-perfusion matching, and respiratory mechanics compared to VCV in a large clinical population of anaesthetised horses.
期刊介绍：
Equine Veterinary Journal publishes evidence to improve clinical practice or expand scientific knowledge underpinning equine veterinary medicine. This unrivalled international scientific journal is published 6 times per year, containing peer-reviewed articles with original and potentially important findings. Contributions are received from sources worldwide.
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