The Use of Intraoperative Positive End Expiratory PressureAhmed Zaky* and John D. Lang
Department of Anesthesiology and Pain Medicine, Puget Sound Health Care System, The University of Washington, Seattle, WA, USA
- *Corresponding Author:
- Ahmed Zaky
Department of Anesthesiology and Pain Medicine
Puget Sound Health Care System, The University of Washington
1660 S Columbian Way, Seattle, WA 98108, S-112-ANES, USA
E-mail: [email protected]
Received date: September 01, 2011; Accepted date: October 11, 2011; Published date: October 15, 2011
Citation: Zaky A, Lang JD (2011) The Use of Intraoperative Positive End Expiratory Pressure. J Anesthe Clinic Res 4:308. doi: 10.4172/2155-6148.1000308
Copyright: © 2011 Zaky A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
General anesthesia is associated with impaired gas exchange mainly because of increased shunt due to atelectasis in the dependent regions of the lung. Postoperative atelectasis is associated with adverse clinical outcomes in terms of hypoxic respiratory failure requiring endotracheal intubation and pneumonia secondary to impairment of ciliary and lymphatic functions. Prevention of atelectasis and/or airway closure could be a mechanism by which positive end expiratory pressure (PEEP) improves oxygenation. Positive end expiratory pressure has been used intraoperatively as a part of open lung and protective lung ventilation strategies. However, it is unclear at the present time whether the intraoperative use of PEEP is associated with a decrease in mortality or in the incidence of other important clinical surrogates of outcome such as postoperative respiratory failure. The aim of this review is to review the physiologic effects and history of PEEP, to present some of the current uses in specific surgical populations and comment on potential benefits on postoperative mortality and pulmonary complications that may be ascribed to intraoperative PEEP use.