British Journal of Anaesthesia, Vol 81, Issue 5 681-686, Copyright © 1998 by The Board of Management and Trustees of the British Journal of Anaesthesia
H. U. Rothen, B. Sporre, G. Engberg, G. Wegenius and G. Hedenstierna
Airway closure and the formation of atelectasis have been proposed as
important contributors to impairment of gas exchange during general
anaesthesia. We have elucidated the relationships between each of these two
mechanisms and gas exchange. We studied 35 adults with healthy lungs,
undergoing elective surgery. Airway closure was measured using the foreign
gas bolus technique, atelectasis was estimated by analysis of computed
x-ray tomography, and ventilation-perfusion distribution (VA/Q) was
assessed by the multiple inert gas elimination technique. The difference
between closing volume and expiratory reserve volume (CV- ERV) increased
from the awake to the anaesthetized state. Linear correlations were found
between atelectasis and shunt (r = 0.68, P < 0.001), and between CV-ERV
and the amount of perfusion to poorly ventilated lung units ("low Va/Q", r
= 0.57, P = 0.001). Taken together, the amount of atelectasis and airway
closure may explain 75% of the deterioration in PaO2. There was no
significant correlation between CV-ERV and atelectasis. We conclude that in
anaesthetized adults with healthy lungs, undergoing mechanical ventilation,
both airway closure and atelectasis contributed to impairment of gas
exchange. Atelectasis and airway closure do not seem to be closely related.
CLINICAL INVESTIGATIONS
Airway closure, atelectasis and gas exchange during general anaesthesia
Department of Anaesthesiology and Intensive Care, University Hospital, Bern, Switzerland; Department of Anaesthesiology and Intensive Care, University Hospital, S-751 85 Uppsala, Sweden; Department of Radiology, University Hospital, S-751 85 Uppsala, Sweden; Department of Clinical Physiology, University Hospital, S-751 85 Uppsala, Sweden
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