Respiratory mechanics after abdominal surgery measured with continuous analysis of pressure, flow and volume signals

We studied 10 patients during the first night after upper abdominal surgery to assess the effect of airway obstruction on chest wall mechanics, by recording nasal gas flow and carbon dioxide concentration, rib cage and abdominal dimensions, abdominal muscle activity, and oesophageal and gastric pres...

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Published inBritish journal of anaesthesia : BJA Vol. 77; no. 3; pp. 317 - 326
Main Authors Nimmo, A F, Drummond, G B
Format Journal Article
LanguageEnglish
Published Oxford Elsevier Ltd 01.09.1996
Oxford University Press
Oxford Publishing Limited (England)
Subjects
Online AccessGet full text
ISSN0007-0912
1471-6771
1471-6771
DOI10.1093/bja/77.3.317

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Abstract We studied 10 patients during the first night after upper abdominal surgery to assess the effect of airway obstruction on chest wall mechanics, by recording nasal gas flow and carbon dioxide concentration, rib cage and abdominal dimensions, abdominal muscle activity, and oesophageal and gastric pressures. The mean duration of study of each subject was 5.8 h, and 5.2 h were analysed. The median proportion of time spent breathing with normal mechanics was 29% (interquartile values 0-57%). Abnormal abdominal mechanical events were common and associated with airway obstruction (P < 0.001). Two common patterns of abnormal pressure and movement were found. In the first, abdominal pressure decreased at the onset of inspiration and there was a phase lag in abdominal movement. The incidence was 33 (14-50)%. In the second pattern, abdominal pressure decreased and in addition the abdominal wall moved inwards at the onset of inspiration. This occurred for 34 (0-52)% of the time. Both patterns were associated with evidence of increased activation of the abdominal muscles during expiration, changing the relationship of abdominal and pleural pressure changes and chest wall movements. Such changes have been interpreted previously as evidence of diaphragm dysfunction.
AbstractList We studied 10 patients during the first night after upper abdominal surgery to assess the effect of airway obstruction on chest wall mechanics, by recording nasal gas flow and carbon dioxide concentration, rib cage and abdominal dimensions, abdominal muscle activity, and oesophageal and gastric pressures. The mean duration of study of each subject was 5.8 h, and 5.2 h were analysed. The median proportion of time spent breathing with normal mechanics was 29% (interquartile values 0-57%). Abnormal abdominal mechanical events were common and associated with airway obstruction (P < 0.001). Two common patterns of abnormal pressure and movement were found. In the first, abdominal pressure decreased at the onset of inspiration and there was a phase lag in abdominal movement. The incidence was 33 (14-50)%. In the second pattern, abdominal pressure decreased and in addition the abdominal wall moved inwards at the onset of inspiration. This occurred for 34 (0-52)% of the time. Both patterns were associated with evidence of increased activation of the abdominal muscles during expiration, changing the relationship of abdominal and pleural pressure changes and chest wall movements. Such changes have been interpreted previously as evidence of diaphragm dysfunction.
We studied 10 patients during the first night after upper abdominal surgery to assess the effect of airway obstruction on chest wall mechanics, by recording nasal gas flow and carbon dioxide concentration, rib cage and abdominal dimensions, abdominal muscle activity, and oesophageal and gastric pressures. The mean duration of study of each subject was 5.8 h, and 5.2 h were analysed. The median proportion of time spent breathing with normal mechanics was 29% (interquartile values 0-57%). Abnormal abdominal mechanical events were common and associated with airway obstruction (P < 0.001). Two common patterns of abnormal pressure and movement were found. In the first, abdominal pressure decreased at the onset of inspiration and there was a phase lag in abdominal movement. The incidence was 33 (14-50)%. In the second pattern, abdominal pressure decreased and in addition the abdominal wall moved inwards at the onset of inspiration. This occurred for 34 (0-52)% of the time. Both patterns were associated with evidence of increased activation of the abdominal muscles during expiration, changing the relationship of abdominal and pleural pressure changes and chest wall movements. Such changes have been interpreted previously as evidence of diaphragm dysfunction.We studied 10 patients during the first night after upper abdominal surgery to assess the effect of airway obstruction on chest wall mechanics, by recording nasal gas flow and carbon dioxide concentration, rib cage and abdominal dimensions, abdominal muscle activity, and oesophageal and gastric pressures. The mean duration of study of each subject was 5.8 h, and 5.2 h were analysed. The median proportion of time spent breathing with normal mechanics was 29% (interquartile values 0-57%). Abnormal abdominal mechanical events were common and associated with airway obstruction (P < 0.001). Two common patterns of abnormal pressure and movement were found. In the first, abdominal pressure decreased at the onset of inspiration and there was a phase lag in abdominal movement. The incidence was 33 (14-50)%. In the second pattern, abdominal pressure decreased and in addition the abdominal wall moved inwards at the onset of inspiration. This occurred for 34 (0-52)% of the time. Both patterns were associated with evidence of increased activation of the abdominal muscles during expiration, changing the relationship of abdominal and pleural pressure changes and chest wall movements. Such changes have been interpreted previously as evidence of diaphragm dysfunction.
Author Drummond, G B
Nimmo, A F
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Issue 3
Keywords Human
Respiratory tract
Respiratory muscle
Respiratory disease
Surgery
Mechanic of breathing
Complication
Obstruction
Abdomen
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SubjectTerms Abdomen
Abdomen - physiopathology
Abdomen - surgery
Adult
Aged
Airway Obstruction - etiology
Airway Obstruction - physiopathology
Analgesia - methods
Analgesics, Opioid - administration & dosage
Biological and medical sciences
Diaphragm - physiopathology
Esophagus - physiopathology
Female
Humans
Male
Medical sciences
Middle Aged
Movement - physiology
Postoperative Complications - physiopathology
Pressure
Respiratory Mechanics - physiology
Stomach - physiopathology
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Thorax - physiopathology
Title Respiratory mechanics after abdominal surgery measured with continuous analysis of pressure, flow and volume signals
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