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Vital capacity manoeuvre in general anaesthesia: useful or useless?

Published online by Cambridge University Press:  23 December 2004

W. Oczenski ,
S. Schwarz  and
R. D. Fitzgerald
W. Oczenski
Affiliation:
Vienna City Hospital-Lainz, Ludwig Boltzmann Institute for Economics of Medicine in Anaesthesia and Intensive Care, Department of Anaesthesia and Intensive Care, Vienna, Austria
S. Schwarz
Affiliation:
Vienna City Hospital-Lainz, Ludwig Boltzmann Institute for Economics of Medicine in Anaesthesia and Intensive Care, Department of Anaesthesia and Intensive Care, Vienna, Austria
R. D. Fitzgerald
Affiliation:
Vienna City Hospital-Lainz, Ludwig Boltzmann Institute for Economics of Medicine in Anaesthesia and Intensive Care, Department of Anaesthesia and Intensive Care, Vienna, Austria
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Extract

Summary

As atelectasis occurs in most patients during general anaesthesia and may be one of the major causes for the development of hypoxaemia and nosocomial pneumonia, its prevention may be considered as an important objective in perioperative management. The major causative mechanisms are the loss of respiratory muscle tone, compression and gas absorption. Vital capacity manoeuvres have been proposed as a means to eliminate atelectasis in the vast majority of patients and restore normal pulmonary gas exchange during general anaesthesia. In this review we describe the pathogenesis of atelectasis in the perioperative period and discuss in the light of recent published investigations the suitability of the vital capacity manoeuvre as a tool during general anaesthesia. Reviewing the current literature, a vital capacity manoeuvre during general anaesthesia may only be useful under specific circumstances when mechanical ventilation with a high inspiratory fraction of oxygen is required or during cardiac surgery at the end of cardiopulmonary bypass to reduce the amount of atelectasis and to maintain adequate gas exchange.

Keywords

ANAESTHESIA, GENERAL, postoperative complicationsLUNG DISEASES, atelectasisRESPIRATORY MECHANICS, vital capacityPOSITIVE PRESSURE RESPIRATION, positive end-expiratory pressure
Type
Review
Information
European Journal of Anaesthesiology , Volume 21 , Issue 4 , April 2004 , pp. 253 - 259
Copyright
2004 European Society of Anaesthesiology

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References

Lindberg P, Gunnarsson L, Tokics L, et al. Atelectasis and lung function in the postoperative period. Acta Anaesthesiol Scand 1992; 36: 546–553.Google Scholar
Lawrence VA, Hilsenbeck SG, Mulrow CD, et al. Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery. J Gen Intern Med 1995; 10: 671–678.Google Scholar
Lam WW, Chen PP, So NM, Metreweli C. Sedation versus general anaesthesia in paediatric patients undergoing chest CT. Acta Radiol 1998; 39: 298–300.Google Scholar
Prys-Roberts C, Nunn JF, Dobson RH, Robinson RH, Greenbaum R, Harris RS. Radiologically undetected pulmonary collapse in the supine position. Lancet 1967; 19: 399–401.Google Scholar
Brismar B, Hedenstierna G, Lundquist H, et al. Pulmonary densities during anaesthesia with muscular relaxation – a proposal of atelectasis. Anesthesiology 1985; 62: 422–428.Google Scholar
Lundquist H, Hedenstierna G, Strandberg A, Tokics L, Brismar B. CT-assessment of dependent lung densities in man during general anaesthesia. Acta Radiol 1995; 36: 626–632.Google Scholar
Strandberg A, Tokics L, Brismar B, Lundquist H, Hedenstierna G. Atelectasis during anaesthesia and in the post-operative period. Acta Anaesthesiol Scand 1986; 30: 154–158.Google Scholar
Tokics L, Hedenstierna G, Strandberg A, Brismar B, Lundquist H. Lung collapse and gas exchange during general anesthesia: effects of spontaneous breathing, muscle paralysis, and positive end-expiratory pressure. Anesthesiology 1987; 66: 157–167.Google Scholar
Gunnarsson L, Tokics L, Gustavsson H, Hedenstierna G. Influence of age on atelectasis formation and gas exchange impairment during general anaesthesia. Br J Anaesth 1991; 66: 423–432.Google Scholar
Eichenberger AS, Proietti S, Wicky S, et al. Morbid obesity and postoperative atelectasis: an underestimated problem. Anesth Analg 2002; 95: 1788–1792.Google Scholar
Rothen HU, Sporre B, Engberg G, Wegenius G, Reber A, Hedenstierna G. Atelectasis and pulmonary shunting during induction of general anaesthesia – can they be avoided? Acta Anaesthesiol Scand 1996; 40: 524–529.Google Scholar
Hedenstierna G. Atelectasis and its prevention during anaesthesia. Eur J Anaesthesiol 1998; 15: 387–390.Google Scholar
Magnusson L, Spahn DR. New concepts of atelectasis during general anaesthesia. Br J Anaesth 2003; 91: 61–72.Google Scholar
Crotti S, Mascheroni D, Caironi P, et al. Recruitment and derecruitment during acute respiratory failure. A clinical study. Am J Respir Crit Care Med 2001; 164: 131–140.Google Scholar
Rothen HU, Sporre B, Engberg G, Wegenius G, Hedenstierna G. Re-expansion of atelectasis during general anaesthesia: a computed tomographic study. Br J Anaesth 1993; 71: 788–795.Google Scholar
Tusman G, Böhm SH, Vazquez de Anda GF, do Campo JL, Lachmann B. ‘Alveolar recruitment strategy’ improves arterial oxygenation during general anaesthesia. Br J Anaesth 1999; 82: 8–13.Google Scholar
Lachmann B. Open up the lung and keep the lung open. Intensive Care Med 1992; 18: 319–321.Google Scholar
Bond DM, McAloon J, Froese AB. Sustained inflations improve respiratory compliance during high frequency oscillatory ventilation but not during large tidal volume positive pressure ventilation in rabbits. Crit Care Med 1994; 22: 1269–1277.Google Scholar
Richard JC, Maggiore S, Mercat A. Where are we with recruitment maneuvers in patients with acute lung injury and acute respiratory distress syndrome? Curr Opin Crit Care 2003; 9: 22–27.Google Scholar
Arnold JH. To recruit or not derecruit: that is the question. Crit Care Med 2002; 30: 1925–1926.Google Scholar
Hedenstierna G, Tokics L, Lundquist H, Andersson T, Strandberg A, Brismar B. Phrenic nerve stimulation during halothane anesthesia. Effects of atelectasis. Anesthesiology 1994; 80: 751–760.Google Scholar
Tokics L, Strandberg A, Brismar B, Lundquist H, Hedenstierna G. Computerized tomography of the chest and gas exchange measurements during ketamine anaesthesia. Acta Anaesthesiol Scand 1987; 31: 684–692.Google Scholar
Rothen HU, Sporre B, Engberg G, Wegenius G, Hogman M, Hedenstierna G. Influence of gas composition on recurrence of atelectasis after a re-expansion maneuver during general anesthesia. Anesthesiology 1995; 82: 832–842.Google Scholar
Tseuda K, Debrand M, Bivins BA, Wright BD, Griffen WO. Pulmonary complications in the morbidly obese following jejunoileal bypass surgery under narcotic anesthesia. Int Surg 1980; 65: 123–129.Google Scholar
Kroenke K, Lawrence VA, Theroux JF, Tuley MR. Operative risk in patients with severe obstructive pulmonary disease. Arch Intern Med 1992; 152: 967–971.Google Scholar
Pedersen T, Eliasen K, Henriksen E. A prospective study of risk factors and cardiopulmonary complications associated with anaesthesia and surgery: risk indicators of cardiopulmonary morbidity. Acta Anaesthesiol Scand 1990; 34: 144–155.Google Scholar
Vazquez de Anda GF, Lachmann B. Protecting the lung during mechanical ventilation with the open lung concept. Acta Anaesthesiol Scand 1998; 112 (Suppl): 63–66.Google Scholar
Bendixen HH, Hedley-Whyte J, Laver MB. Improved oxygenation in surgical patients during general anesthesia with controlled ventilation. N Engl J Med 1963; 269: 991–996.Google Scholar
Greaves IA, Hildebrandt J, Hoppin FG. Micromechanics of the lung. In: Macklem PT, Mead J, Bethesda MD, eds. Handbook of Physiology.American Society of Physiology1985: 217–231.
Rothen HU, Sporre B, Engberg G, Wegenius G, Reber A, Hedenstierna G. Prevention of atelectasis during general anaesthesia. Lancet 1995; 345: 1387–1391.Google Scholar
Rothen HU, Sporre B, Engberg G, Wegenius G, Hedenstierna G. Re-expansion of atelectasis during general anaesthesia may have a prolonged effect. Acta Anaesthesiol Scand 1995; 39: 118–125.Google Scholar
Rothen HU, Neumann P, Berglund JE, Valtysson J, Magnusson A, Hedenstierna G. Dynamics of re-expansion of atelectasis during general anaesthesia. Br J Anaesth 1999; 82: 551–556.Google Scholar
Tusman G, Böhm SH, Melkun F, et al. Alveolar recruitment strategy increases arterial oxygenation during one-lung ventilation. Ann Thorac Surg 2002; 73: 1204–1209.Google Scholar
Dreyfuss D, Soler P, Basset G, Saumon G. High inflation pressure pulmonary edema: respective effects of high airway pressure. Am Rev Respir Dis 1988; 137: 1159–1164.Google Scholar
Dreyfuss D, Saumon G. Barotrauma is volutrauma, but which volume is the one responsible? Intensive Care Med 1992; 18: 139–141.Google Scholar
Hedenstierna G, Edmark L, Aherdan KK. Time to reconsider the pre-oxygenation during induction of anaesthesia. Minerva Anesthesiol 2000; 66: 293–296.Google Scholar
Edmark L, Kostova-Aherdan K, Enlund M, Hedenstierna G. Optimal oxygen concentration during induction of general anesthesia. Anesthesiology 2003; 98: 28–33.Google Scholar
Benoit Z, Wicky S, Fischer JF, et al. The effect of increased FiO2 before tracheal extubation on postoperative atelectasis. Anesth Analg 2002; 95: 1777–1781.Google Scholar
Neumann P, Rothen HU, Berglund JE, Valtysson A, Magnusson A, Hedenstierna G. Positive endexpiratory pressure prevents atelectasis during general anesthesia even in the presence of a high inspired oxygen concentration. Acta Anaesthesiol Scand 1999; 43: 295–301.Google Scholar
Tusman G, Böhm ST, Tempra A, et al. Effects of recruitment maneuver on atelectasis in anesthetized children. Anesthesiology 2003; 98: 14–22.Google Scholar
Hachenberg T, Tenling A, Nystrom SO, Tyden H, Hedenstierna G. Ventilation-perfusion inequality in patients undergoing cardiac surgery. Anesthesiology 1994; 80: 509–519.Google Scholar
Cox CM, Ascione R, Cohen AM, Davies IM, Ryder IG, Angelini GD. Effect of cardiopulmonary bypass on pulmonary gas exchange: a prospective randomized study. Ann Thorac Surg 2000; 69: 140–145.Google Scholar
Magnusson L, Zemgulis V, Wicky S, Tyden H, Thelin S, Hedenstierna G. Atelectasis is a major cause of hypoxemia and shunt after cardiopulmonary bypass: an experimental study. Anesthesiology 1997; 87: 1153–1163.Google Scholar
Tenling A, Hachenberg T, Tyden H, Wegenius G, Hedenstierna G. Atelectasis and gas exchange after cardiac surgery. Anesthesiology 1998; 89: 371–378.Google Scholar
Magnusson L, Zemgulis V, Tenling A, et al. Use of vital capacity maneuver to prevent atelectasis after cardiopulmonary bypass: an experimental study. Anesthesiology 1998; 88: 134–142.Google Scholar
Tschernko EM, Bambazek A, Wisser W, et al. Intrapulmonary shunt after cardiopulmonary bypass: the use of vital capacity maneuvers versus off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg 2002; 124: 732–738.Google Scholar
Murphy GS, Szokol JW, Curran RD, Votapka TV, Vender JS. Influence of vital capacity maneuver on pulmonary gas exchange after cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2001; 15: 336–340.Google Scholar
Claxton BA, Morgan P, McKeague H, Mulpur A, Berridge J. Alveolar recruitment strategy improves arterial oxygenation after cardiopulmonary bypass. Anaesthesia 2003; 58: 111–116.Google Scholar
Dyhr T, Laursen N, Larsson A. Effects of lung vital capacity maneuver and positive end-expiratory pressure on lung volume, respiratory mechanics and alveolar gas mixing in patients ventilated after cardiac surgery. Acta Anaesthesiol Scand 2002; 46: 717–725.Google Scholar
Magnusson L, Zemgulis V, Wicky S, Tyden H, Hedenstierna G. Effect of CPAP during cardiopulmonary bypass on postoperative function. An experimental study. Acta Anaesthesiol Scand 1998; 42: 1133–1138.Google Scholar
Loeckinger A, Kleinsasser A, Lindner KH, Margreiter J, Keller C, Hoermann C. Continuous positive airway pressure at 10 cmH2O during cardiopulmonary bypass improves postoperative gas exchange. Anesth Analg 2000; 91: 522–527.Google Scholar
Pelosi P, Croci M, Ravagnan I, et al. Respiratory system mechanics in sedated, paralyzed, morbidly obese patients. J Appl Physiol 1997; 82: 811–818.Google Scholar
Pelosi P, Croci M, Ravagnan I, et al. The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia. Anesth Analg 1998, 87: 654–660.Google Scholar
Coussa M, Proietti S, Frascarolo P, Spahn D, Magnusson L. Continuous positive airway pressure prevents atelectasis formation during induction of general anaesthesia in morbidly obese patients. Swiss Med Wkly 2002; 132: 53.Google Scholar
Pelosi P, Ravagnan I, Giurati G, et al. Positive end-expiratory pressure improves respiratory function in obese but not in normal subjects during anesthesia and paralysis. Anesthesiology 1999; 91: 1221–1231.Google Scholar
D'Angelo E, Calderini E, Tavola M, Bono D, Milic-Emili J. Effect of PEEP on respiratory mechanics in anesthetized paralyzed humans. J Appl Physiol 1992; 73: 1736–1742.Google Scholar
Santesson J. Oxygen transport and venous admixture in the extreme obese: influence of anaesthesia and artificial ventilation with and without positive end-expiratory pressure. Acta Anaesthesiol Scand 1976; 20: 387–394.Google Scholar