Total Respiratory System, Lung, and Chest Wall Mechanics in Sedated-Paralyzed Postoperative Morbidly Obese Patients

Paolo Pelosi, Massimo Croci, Irene Ravagnan, Pierluigi Vicardi, Luciano Gattinoni

Research output: Contribution to journalArticle

256 Citations (Scopus)

Abstract

Objective: To study the relative contribution of the lung and the chest wall on the total respiratory system mechanics, gas exchange, and work of breathing in sedated-paralyzed normal subjects and morbidly obese patients, in the postoperative period. Setting: Policlinico Hospital, University of Milan, Italy. Methods: In ten normal subjects (normal) and ten morbidly obese patients (obese), we partitioned the total respiratory mechanics (rs) into its lung (L) and chest wall (w) components using the esophageal balloon technique together with airway occlusion technique, during constant flow inflation. We measured, after abdominal surgery, static respiratory system compliance (Cst,rs), lung compliance (Cst,L), chest wall compliance (Cst,w), total lung (Rmax,L) and chest wall (Rmax,w) resistance. Rmax,L includes airway (Rmin,L) and "additional" lung resistance (DR,L). DR,L represents the component due to viscoelastic phenomena of the lung tissue and time constant inequalities (pendelluft). Functional residual capacity (FRC) was measured by helium dilution technique. Results: We found that morbidly obese patients compared with normal subjects are characterized by the following: (1) reduced Cst,rs (p2O-1 vs 106.6±31.7 mLxcm H2O-1; p2O-1 vs 190.7±45.1 mLxcm H2O-1; p2OxL-1xs; vs 1.0±0.8 mLxcm H2OxL-1xs; p2OxL-1xs; vs 1.5±0.8 mLxcm H2OxL-1xs; p2/PAO2 ratio). Conclusion: Sedated-paralyzed morbidly obese patients, compared with normal subjects, are characterised by marked derangements in lung and chest wall mechanics and reduced lung volume after abdominal surgery. These alterations may account for impaired arterial oxygenation in the postoperative period.

Original languageEnglish
Pages (from-to)144-151
Number of pages8
JournalChest
Volume109
Issue number1
Publication statusPublished - 1996

Fingerprint

Thoracic Wall
Mechanics
Respiratory System
Lung
Respiratory Mechanics
Lung Compliance
Postoperative Period
Work of Breathing
Functional Residual Capacity
Indicator Dilution Techniques
Helium
Economic Inflation
Italy
Compliance
Gases

Keywords

  • Anesthesia
  • Gas-exchange
  • Mechanical ventilation
  • Morbid obesity
  • Respiratory mechanics

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Pelosi, P., Croci, M., Ravagnan, I., Vicardi, P., & Gattinoni, L. (1996). Total Respiratory System, Lung, and Chest Wall Mechanics in Sedated-Paralyzed Postoperative Morbidly Obese Patients. Chest, 109(1), 144-151.

Total Respiratory System, Lung, and Chest Wall Mechanics in Sedated-Paralyzed Postoperative Morbidly Obese Patients. / Pelosi, Paolo; Croci, Massimo; Ravagnan, Irene; Vicardi, Pierluigi; Gattinoni, Luciano.

In: Chest, Vol. 109, No. 1, 1996, p. 144-151.

Research output: Contribution to journalArticle

Pelosi, P, Croci, M, Ravagnan, I, Vicardi, P & Gattinoni, L 1996, 'Total Respiratory System, Lung, and Chest Wall Mechanics in Sedated-Paralyzed Postoperative Morbidly Obese Patients', Chest, vol. 109, no. 1, pp. 144-151.
Pelosi, Paolo ; Croci, Massimo ; Ravagnan, Irene ; Vicardi, Pierluigi ; Gattinoni, Luciano. / Total Respiratory System, Lung, and Chest Wall Mechanics in Sedated-Paralyzed Postoperative Morbidly Obese Patients. In: Chest. 1996 ; Vol. 109, No. 1. pp. 144-151.
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AB - Objective: To study the relative contribution of the lung and the chest wall on the total respiratory system mechanics, gas exchange, and work of breathing in sedated-paralyzed normal subjects and morbidly obese patients, in the postoperative period. Setting: Policlinico Hospital, University of Milan, Italy. Methods: In ten normal subjects (normal) and ten morbidly obese patients (obese), we partitioned the total respiratory mechanics (rs) into its lung (L) and chest wall (w) components using the esophageal balloon technique together with airway occlusion technique, during constant flow inflation. We measured, after abdominal surgery, static respiratory system compliance (Cst,rs), lung compliance (Cst,L), chest wall compliance (Cst,w), total lung (Rmax,L) and chest wall (Rmax,w) resistance. Rmax,L includes airway (Rmin,L) and "additional" lung resistance (DR,L). DR,L represents the component due to viscoelastic phenomena of the lung tissue and time constant inequalities (pendelluft). Functional residual capacity (FRC) was measured by helium dilution technique. Results: We found that morbidly obese patients compared with normal subjects are characterized by the following: (1) reduced Cst,rs (p2O-1 vs 106.6±31.7 mLxcm H2O-1; p2O-1 vs 190.7±45.1 mLxcm H2O-1; p2OxL-1xs; vs 1.0±0.8 mLxcm H2OxL-1xs; p2OxL-1xs; vs 1.5±0.8 mLxcm H2OxL-1xs; p2/PAO2 ratio). Conclusion: Sedated-paralyzed morbidly obese patients, compared with normal subjects, are characterised by marked derangements in lung and chest wall mechanics and reduced lung volume after abdominal surgery. These alterations may account for impaired arterial oxygenation in the postoperative period.

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