Skip to Main content Skip to Navigation
Master Thesis

Ventilation non invasive prophylactique puis curative : étude de la mécanique ventilatoire après résection pulmonaire en chirurgie thoracique

Abstract : Introduction: lung resection surgery is a source of inflammation, atelectasis and postoperative complications, which can be prevented or treated by noninvasive ventilation (NIV). However, spontaneous ventilation at high tidal volumes above 8mL.kg-1 of predicted body weight (VT PBW) can lead to overdistension and high transpulmonary pressure, by decreasing the respiratory system’s compliance (Crs). The aim of this study was to compare the VT PBW of patients receiving NIV for acute respiratory failure (ARF) following lung resection at 3 stages: during prophylaxis, at the acme of hypoxemia, and then one hour after intubation (if it occurred). Methods: this retrospective cohort study included 21 patients between july 2016 and december 2017. Postoperative VT were estimated with Juhl & Frost formula and called VT anat. Results: Both VT PBW and VT anat were higher in curative NIV compared to prophylaxis (VT PBW =8.0 [6.5-10] versus 11.2 [9.9-12.7] mL.kg-1 and VT anat= 10.5 [8.5-12.2] versus 14.6 [12.116.3] mL.kg-1 (p<0.05). Inspiratory pressure levels were similar in both types of NIV (5 [5-8] and 5 [4-6] cmH2O). Patients needing intubation showed, during curative NIV a higher respiratory rate compared to not intubated patients (RR= 33 [26-36] versus 26 [24-30], p= 0.05) but a lower PaO2/FiO2 ratio (105 [96-112] versus 131 [112-217] p= 0.02). In the intubated group Crs= 13 [12-17] ml.cmH2O-1, predicting high driving pressures. Discussion: tidal volumes during curative NIV were all excessive despite low levels of inspiratory pressure. Low Crs predicted high driving pressure under curative NIV. Alveolar overdistension in spontaneous ventilation after lung resection is therefore frequent under curative NIV. Conclusion: the only way to control compensatory hyperventilation observed in ARF after lung resection, is probably early sedation and intubation, in order to guarantee protective ventilation.
Complete list of metadatas

Cited literature [119 references]  Display  Hide  Download

https://dumas.ccsd.cnrs.fr/dumas-02419007
Contributor : Médecine Ub <>
Submitted on : Thursday, December 19, 2019 - 11:37:31 AM
Last modification on : Saturday, January 18, 2020 - 1:30:24 AM
Long-term archiving on: : Friday, March 20, 2020 - 4:43:49 PM

File

 Restricted access
To satisfy the distribution rights of the publisher, the document is embargoed until : 2021-04-19

Please log in to resquest access to the document

Identifiers

  • HAL Id : dumas-02419007, version 1

Collections

Citation

Rabia Sibaï. Ventilation non invasive prophylactique puis curative : étude de la mécanique ventilatoire après résection pulmonaire en chirurgie thoracique. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02419007⟩

Share

Metrics

Record views

21