Bein, Thomas and Reber, A. (1999) Atelectasis during anaesthesia and intensive care medicine - Pathophysiology and therapeutic concepts. ANASTHESIOLOGIE & INTENSIVMEDIZIN, 40 (6). pp. 477-486. ISSN 0170-5334,
Full text not available from this repository. (Request a copy)Abstract
Induction of anaesthesia and muscle paralysis cause a decrease in the transverse thoracic area and a cranial shift of the diaphragm. The consecutive reduction of the functional residual capacity is associated with lung collapse and a decrease of the arterial oxygenation. Additionally, pre-oxygenation and insufflation of 100 % oxygen induce alveolar replacement of nitrogen by oxygen and therefore promote further collapse of lung tissue. The reduction of the pulmonary gas exchange capacity due to atelectasis is a relevant problem in clinical anaesthesia and in intensive care medicine. In several studies, using the techniques of chest computed tomography and the assessment of ventilation-perfusion relationships, the pathophysiological consequences of lung collapse and atelectasis have been shown. After induction of anaesthesia and in artificially ventilated intensive care patients, atelectatic areas in the dorso-basal lung regions are found with an increased intrapulmonary shunt fraction and a global ventilation-perfusion mismatch. Therapeutic strategies include intermittent recruitment manoeuvres during anaesthesia and an optimisation of the fractional inspiratory oxygen concentration. In intensive care medicine, periodic changes of the patient's position (ventilation in prone position, kinetic therapy) are advocated as effective methods for an increase in arterial oxygenation. Furthermore, an "open-lung"-concept is introduced for a periodic recruitment of atelectatic areas. We illustrate the pathophysiology of lung collapse and intrapulmonary shunt. In addition, we discuss actual therapeutic options and possible side effects to promote careful applications of these techniques.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | VENTILATION-PERFUSION RELATIONSHIPS; FUNCTIONAL RESIDUAL CAPACITY; PULMONARY BLOOD-FLOW; ACUTE RESPIRATORY-FAILURE; GAS-EXCHANGE IMPAIRMENT; GENERAL-ANESTHESIA; MUSCLE PARALYSIS; PRE-OXYGENATION; MECHANICAL VENTILATION; COMPUTED-TOMOGRAPHY; anaesthesia; critical care; respiration, artificial; atelectasis |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Anästhesiologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 23 Nov 2022 06:57 |
| Last Modified: | 23 Nov 2022 06:57 |
| URI: | https://pred.uni-regensburg.de/id/eprint/48601 |
Actions (login required)
 |
View Item |
