Influence of Low-tidal Volume and Positive End Expiratory Pressure Protective Ventilation on Cardiac Output Volume in Elderly Patients under General Anesthesia_West China Medical Journal

Authors：

 LiWei , LiuWenzhi , ZhuYuehao , LiQuanlin , DengYijiang , LiuMin

Department of Anesthesia, the Affiliated Hospital of Panzhihua University/Integrated Traditional Chinese and Western Medicine Hospital of Panzhihua, Panzhihua, Sichuan 617000, P. R. China;

Corresponding author：

Keywords：

Low-tidal volume; Positive end expiratory pressure; Elderly; Cardiac output; General anesthesia

DOI：

10.7507/1002-0179.201600192

Video：

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Objective To study the influence of low-tidal volume and positive end expiratory pressure (PEEP) protective ventilation on cardiac output volume in elderly patients under general anesthesia. Methods From August 2012 to July 2014, 60 elderly patients undergoing selective surgery were divided into three groups with 20 patients in each. Group A was treated with conventional ventilation: tidal volume at 8 mL/kg, PEEP at 0 cm H₂O (1 cm H₂O=0.098 kPa); group B was treated with a tidal volume of 6 mL/kg and a PEEP of 5 cm H₂O; group C was treated with a tidal volume of 6 mL/kg and a PEEP of 8 cm H₂O. We then observed and analyzed the blood pressure, heart rate, cardiac output, arterial blood gas and airway mean pressure before induction of anesthesia (T₀), 15 minutes of mechanical ventilation after the induction of anesthesia (T₁), 60 minutes after anesthesia induction (T₂), and 15 minutes after tracheal extubation (T₃). Results In all the three groups, the mean arterial pressure and cardiac output were stable. In group B and C, central venous pressure increased significantly, the mean airway pressure and lung compliance increased, and the arterial oxygen branch pressure also increased significantly (P < 0.05). Conclusion Low-tidal volume combined with 5-cm H₂O or 8-cm H₂O positive end expiratory pressure lung-protective ventilation had a small influence on the cardiac output of elderly patients under anesthesia, which can be safely used.

Citation： LiWei, LiuWenzhi, ZhuYuehao, LiQuanlin, DengYijiang, LiuMin. Influence of Low-tidal Volume and Positive End Expiratory Pressure Protective Ventilation on Cardiac Output Volume in Elderly Patients under General Anesthesia. West China Medical Journal, 2016, 31(4): 704-709. doi: 10.7507/1002-0179.201600192 Copy

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6.	龚华, 张丽娜, 蔡宏伟, 等. 全身麻醉中低潮气量机械通气对患者肺泡不张发生的影响[J]. 中华麻醉学杂志, 2007, 27(5): 408-411.
7.	庄心良, 曾因明, 陈伯鉴. 现代麻醉学[M]. 3版. 北京: 人民卫生出版社, 2003: 1145-1146.
8.	Tweed WA, Phua WT, Chong KY, et al. Tidal volume, lung hyperinflation and arterial oxygenation during general anaesthesia[J]. Anaesth Intensive Care, 1993, 21(6): 806-810.
9.	Jonson B, Uttman L. Efficient gas exchange with low tidal volume ventilation in acute respiratory distress syndrome[J]. J Organ Dysfunct, 2007, 3(2): 82-89.
10.	Caricato A, Conti G, Della CF, et al. Effects of PEEP on the intracranial system of patients with head injury and subarachnoid hemorrhage: the role of respiratory system compliance[J]. J Trauma, 2005, 58(3): 571-576.
11.	Loeckinger A, Kleinsasser A, Hoermann C, et al. Inert gas exchange during pneumoperitoneum at incremental values of positive end-expiratory pressure[J]. Anesth Analg, 2000, 90(2): 466-471.
12.	Denault AY, Gorcsan J, Pinsky MR. Dynamic effects of positive-pressure ventilation on canine left ventricular pressure-volume relations[J]. J Appl Physiol, 2001, 91(1): 298-308.
13.	Shekerdemian L, Bohn D. Cardiovascular effects of mechanical ventilation[J]. Arch Dis Child, 1999, 80(5): 475-480.
14.	Michard F, Tcboul JL. Using heard-lung interactions to asses fluid responsiveness during mechanical ventilation[J]. Crit Care, 2000, 4(5): 282-289.
15.	Harder LA. Bleeding after cardiopulmonary[J]. N Eng J Med, 1986, 314(22): 1446-1448.
16.	Steingrub JS, Tidswell M, Higgins TL. Hemodynamic consequences of heart-lung interactions[J]. J Intensive Care Med, 2004, 18(2): 92-99.

1. 潘志龙, 夏禹唱, 金子健, 等. 不同水平呼气末正压联合小潮气量通气对老年患者围麻醉期呼吸功能及血流动力学的影响[J]. 现代实用医学, 2013, 25(6): 675-677.
2. Lucc JM. Acute lung injury and acute respiratory distress syndrome[J]. Crit Care Med, 1998, 26(2): 369-376.
3. Schultz MJ, Haitsma JJ, Slutsky AS, et al. What tidal volumes should be used in patients without ALI/ARDS[J]. Anesthesiology, 2007, 106(6): 1226-1231.
4. Briel MA. Higher vs lower positive end expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis[J]. JAMA, 2010, 303(9): 865-873.
5. 邵益萍, 潘学文, 朱卫东. 非开胸手术患者静脉全麻中肺顺应性的变化[J]. 中华麻醉学杂志, 2005, 25(5): 399.
6. 龚华, 张丽娜, 蔡宏伟, 等. 全身麻醉中低潮气量机械通气对患者肺泡不张发生的影响[J]. 中华麻醉学杂志, 2007, 27(5): 408-411.
7. 庄心良, 曾因明, 陈伯鉴. 现代麻醉学[M]. 3版. 北京: 人民卫生出版社, 2003: 1145-1146.
8. Tweed WA, Phua WT, Chong KY, et al. Tidal volume, lung hyperinflation and arterial oxygenation during general anaesthesia[J]. Anaesth Intensive Care, 1993, 21(6): 806-810.
9. Jonson B, Uttman L. Efficient gas exchange with low tidal volume ventilation in acute respiratory distress syndrome[J]. J Organ Dysfunct, 2007, 3(2): 82-89.
10. Caricato A, Conti G, Della CF, et al. Effects of PEEP on the intracranial system of patients with head injury and subarachnoid hemorrhage: the role of respiratory system compliance[J]. J Trauma, 2005, 58(3): 571-576.
11. Loeckinger A, Kleinsasser A, Hoermann C, et al. Inert gas exchange during pneumoperitoneum at incremental values of positive end-expiratory pressure[J]. Anesth Analg, 2000, 90(2): 466-471.
12. Denault AY, Gorcsan J, Pinsky MR. Dynamic effects of positive-pressure ventilation on canine left ventricular pressure-volume relations[J]. J Appl Physiol, 2001, 91(1): 298-308.
13. Shekerdemian L, Bohn D. Cardiovascular effects of mechanical ventilation[J]. Arch Dis Child, 1999, 80(5): 475-480.
14. Michard F, Tcboul JL. Using heard-lung interactions to asses fluid responsiveness during mechanical ventilation[J]. Crit Care, 2000, 4(5): 282-289.
15. Harder LA. Bleeding after cardiopulmonary[J]. N Eng J Med, 1986, 314(22): 1446-1448.
16. Steingrub JS, Tidswell M, Higgins TL. Hemodynamic consequences of heart-lung interactions[J]. J Intensive Care Med, 2004, 18(2): 92-99.

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Influence of Low-tidal Volume and Positive End Expiratory Pressure Protective Ventilation on Cardiac Output Volume in Elderly Patients under General Anesthesia

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