Respiratory mechanics at different PEEP levels during general anesthesia in the elderly: A pilot study

E. Marangoni, V. Alvisi, R. Ragazzi, F. Mojoli, R. Alvisi, G. Caramori, L. Astolfi, C. A. Volta

Research output: Contribution to journalArticlepeer-review


Background. General anesthesia could imply that the closing capacity exceed the functional residual capacity. This phenomenon, associated with a reduction of maximal expiratory flow, could lead to expiratory flow limitation (EFL). The aim of our study was to verify 1) a new method of determining EFL during anesthesia (PEEP test); 2) if anesthesia could be associated with the development of EFL; 3) if the use a small amount of PEEP is able to reverse the possible negative effects of low lung volume ventilation. Methods. Fifty two patients scheduled for abdominal surgery were prospectively randomized in: 1) group ZEEP, ventilated at PEEP 0 H2O and 2) group PEEP ventilated at PEEP 5 cm H2O. The presence of EFL was determined by the negative expiratory pressure (NEP) test the day before surgery and by the PEEP test during surgery. Data of respiratory mechanics were calculated at the beginning and at the end of anesthesia. Results. 1) The PEEP test allows the detection of EFL; 2) anesthesia was associated with EFL: 8 patients developed EFL after induction. At the end of surgery, 7 more patients became flow limited in the group ZEEP, while only 1 in the group PEEP. The group ZEEP exhibited a marked decrease of expiratory flow and a worsening of respiratory mechanics at the end of surgery. Conclusion. The PEEP test allowed to verify that EFL during anesthesia is a valuable phenomenon. The use of 5 cmH2O of PEEP was helpful to prevent the deterioration of lung mechanics that occurs during surgery.

Original languageEnglish
Pages (from-to)1205-1214
Number of pages10
JournalMinerva Anestesiologica
Issue number11
Publication statusPublished - Nov 2012


  • Anesthesia, general
  • Positive-pressure respiration
  • Respiratory mechanics

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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