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BJA Advance Access published online on May 13, 2009
British Journal of Anaesthesia, doi:10.1093/bja/aep102
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Development of atelectasis and arterial to end-tidal PCO2-difference in a porcine model of pneumoperitoneum

C. M. Strang1,3, T. Hachenberg3, F. Fredén2 and G. Hedenstierna1,*

1 Department of Medical Sciences, Clinical Physiology
2 Department of Surgical Science, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
3 Department of Anaesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Germany

* Corresponding author. E-mail: goran.hedenstierna{at}medsci.uu.se

Background: Intraperitoneal insufflation of carbon dioxide (CO2) may promote collapse of dependent lung regions. The present study was undertaken to study the effects of CO2-pneumoperitoneum (CO2-PP) on atelectasis formation, arterial oxygenation, and arterial to end-tidal PCO2-gradient (Pa-E'CO2).

Methods: Fifteen anaesthetized pigs [mean body weight 28 (SD 2) kg] were studied. Spiral computed tomography (CT) scans were obtained for analysis of lung tissue density. In Group 1 (n=5) mechanical ventilation (VT=10 ml kg –1, FIO2=0.5) was applied, in Group 2 (n=5) FIO2 was increased for 30 min to 1.0 and in Group 3 (n=5) negative airway pressure was applied for 20 s in order to enhance development of atelectasis. Cardiopulmonary and CT data were obtained before, 10, and 90 min after induction of CO2-PP at an abdominal pressure of 12 mmHg.

Results: Before CO2-PP, in Group 1 non-aerated tissue on CT scans was 1 (1)%, in Group 2 3 (2)% (P<0.05, compared with Group 1), and in Group 3 7 (3)% (P<0.05, compared with Group 1 and Group 2). CO2-PP significantly increased atelectasis in all groups. PaO2/FIO2 fell and venous admixture (‘shunt’) increased in proportion to atelectasis during anaesthesia but CO2-PP had a varying effect on PaO2/FIO2 and shunt. Thus, no correlation was seen between atelectasis and PaO2/FIO2 or shunt when all data before and during CO2-PP were pooled. Pa-E'CO2, on the other hand correlated strongly with the amount of atelectasis (r2=0.92).

Conclusions: Development of atelectasis during anaesthesia and PP may be estimated by an increased Pa-E'CO2.

Keywords: lung, atelectasis; measurement techniques, computed tomography; model, pig; partial pressure; Pa–PE'CO2 ratio; Surgery, laparoscopy


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