Canadian Journal of Anaesthesia

, Volume 38, Issue 8, pp 989–995 | Cite as

Large tidal volume ventilation improves pulmonary gas exchange during lower abdominal surgery in Trendelenburg’s position

  • W. A. Tweed
  • W. T. Phua
  • K. Y. Chong
  • E. Lim
  • T. L. Lee
Reports on Investigation


Impaired pulmonary gas exchange is a common complication of general anaesthesia. Periodic hyperinflation of the lungs and large tidal volume ventilation were the first preventive measures to be widely embraced, but their effectiveness in clinical practice has never been clearly established by controlled clinical studies. To assess their effects in high-risk patients we studied 24 adults having lower abdominal gynaecological surgery in the Trendelenburg (head down) position. Pulmonary oxygen exchange was determined during four steady-states: awake control (AC), after 30 min of conventional tidal volume (CVt, 7.5 ml · kg−1) or high tidal volume (HVt, 12.7 ml · kg−1) ventilation, introduced in random order, and five minutes after manual hyperinflations (HI) of the lungs. The patients’ lungs were ventilated with air/O2 by an Ohmeda volume-controlled ventilator via a circle system. TheFiO2 was controlled at 0.5, andFETCO2 was controlled by adding dead space during HVt. Arterial blood gas analysis was used to calculate the oxygen tension-based indices of gas exchange.

There was significant deterioration of (A-a)DO2 at 30 min in Group A, whose lungs were first ventilated with CVt (81.6 ± 7.2 to 166.8 ± 13.7 mmHg, P < 0.001); but not in Group B, whose lungs were first ventilated with HVt(77.0 ± 9.9 to 104.4 ± 16.8 mmHg). When Group A and B data were pooled there was no difference between randomized CVT and HVt, but improvement occurred after HI. In this model of compromised O2 exchange large inflation volumes (HVt and HI) were of considerable clinical benefit, HVt prevented and HI reversed the gas exchange disorder.

Key words

lung: gas exchange, shunting ventilation: artificial, tidal volume, oxygen tension (gradients), shunting oxygen: blood levels, gradients, tension 


L’anesthésie génerale perturbe souvent les échanges gazeux pulmonaires. L’hyperinflation intermittente des poumons et la ventilation pulmonaire à grand volume courant ont très tôt servi à pallier à ce probléme même si leur efficacité n’a jamais été démontrée en clinique. Nous avons mesuré l’impact de ces deux manoeuvres chez 24 patientes en Trendelenburg lors d’interventions chirurgicales abdominales basses (gynécologiques). On mesurait le transfert pulmonaire de l’oxygéne à quatre occasions: avant l’induction de l’anesthésie (EV), après 30 min de ventilation avec volume courant conventionnel (VcC, 7,5 ml · kg− 1)ou avec grand volume courant (VcG, 12,7 ml · kg− 1), l’ordre étant déterminé au hasard, et cinq minutes après hyperinflation pulmonaire (HP). C’est un ventilateur volumé-trique d’Ohmeda branché sur un système anesthésique en cercle qui assurait la ventilation pulmonaire avec un mélange d’air et d’oxyg`ene, uneFiO2 de 0,5 et uneFETCO2 ajustée grâce à l’ajout d’espace mort lors de laVcG. On mesurait les gaz artériels pour calculer le gradient alvéolo-artériel pour l’oxy-gène ((A-a) DO2).

On notait une détérioration significative de ce dernier à 30 min chez le groupe A, ventilation enVcC d’abord (81,6 ± 7,2 à 166,8 ± 13,7 mmHg, P < 0,001) mais non chez le groupe B, ventilation enVcG d’abord (77,0 ± 9,9 à 104,4 ± 16,8 mmHg). Toutefois, une fois regroupées les données des groupes A et B, on n’identifiait pas de différence entre leVcC et leVcG, mais on notait une amélioration après HP. Avec ce modèle clinique où l’oxygénation était compromise, on a démontré que de grandes insufflations pulmonaires (VcG et HP) offraient un avantage considerable; l’usage de grands volumes courants prévenait et l’hyperinflation pulmonaire corrigeait les anomalies des échanges gazeux.


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Copyright information

© Canadian Anesthesiologists 1991

Authors and Affiliations

  • W. A. Tweed
    • 1
  • W. T. Phua
    • 1
  • K. Y. Chong
    • 1
  • E. Lim
    • 1
  • T. L. Lee
    • 1
  1. 1.Department of Anaesthesia, National University HospitalNational University of SingaporeSingapore

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