The effect of increased FIO(2) before tracheal extubation on postoperative atelectasis

Details

Serval ID
serval:BIB_F0AA04D16E43
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
The effect of increased FIO(2) before tracheal extubation on postoperative atelectasis
Journal
Anesthesia and Analgesia
Author(s)
Benoit  Z., Wicky  S., Fischer  J. F., Frascarolo  P., Chapuis  C., Spahn  D. R., Magnusson  L.
ISSN
0003-2999 (Print)
Publication state
Published
Issued date
12/2002
Volume
95
Number
6
Pages
1777-81, table of contents
Notes
Clinical Trial
Journal Article
Randomized Controlled Trial --- Old month value: Dec
Abstract
General anesthesia promotes pulmonary atelectasis, which can be eliminated by a vital capacity (VC) maneuver (inflation of the lungs to 40 cm H(2)O for 15 s). High-inspired oxygen concentration favors recurrence of atelectasis. Therefore, 100% oxygen before tracheal extubation may contribute to atelectasis. To evaluate whether the use of 100% oxygen before extubation increases the amount of postoperative atelectasis, we studied 30 adults scheduled for elective surgery of the extremities. Ten minutes before the presumed end of surgery, patients were randomly assigned to (a) a fraction of inspired oxygen (FIO(2)) = 1.0 (n = 10), (b) VC maneuver + FIO(2) = 1.0 (n = 10), or (c) VC maneuver + FIO(2) = 0.4 (n = 10). The amount of atelectasis was measured by computed tomography scan, and oxygenation was studied by arterial blood gas analysis. Data were analyzed by one-way analysis of variance with Bonferroni correction. Results are presented as mean +/- SD; P < 0.05 was considered significant. In the VC maneuver + FIO(2) = 0.4 group, postoperative atelectasis was smaller (2.6% +/- 1.1% of total lung surface, P < 0.05) than in the FIO(2) = 1.0 group (8.3% +/- 6.2%) and in the VC maneuver + FIO(2) = 1.0 group (6.8% +/- 3.4%). Oxygen 100% at the end of general anesthesia promotes postoperative atelectasis. A safety margin in terms of oxygenation during tracheal extubation is essential, and further studies should therefore evaluate whether atelectasis formation could be prevented despite the use of 100% oxygen. IMPLICATIONS: For safety reasons, it is common to ventilate patients with 100% oxygen before tracheal extubation. This study demonstrates that this practice favors postoperative atelectasis.
Keywords
Adolescent Adult Atelectasis/*etiology/physiopathology Double-Blind Method Female Humans *Intubation, Intratracheal Male Middle Aged Oxygen/*adverse effects Postoperative Complications/*etiology Prospective Studies Vital Capacity
Pubmed
Web of science
Create date
28/01/2008 11:51
Last modification date
20/08/2019 17:18
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