Total respiratory system, lung, and chest wall mechanics in sedated-paralyzed postoperative morbidly obese patients.
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.


METHODS
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 (p < 0.01), due to lower Cst,L (55.3 +/- 15.3 mL x cm H2O-1 vs 106.6 +/- 31.7 mL x cm H2O-1; p < 0.01) and Cst,w (112.4 +/- 47.4 mL x cm H2O-1 vs 190.7 +/- 45.1 mL x cm H2O-1; p < 0.01); (2) increased Rmin,L (4.7 +/- 3.1 mL x cm H2O x L-1 x s; vs 1.0 +/- 0.8 mL x cm H2O x L-1 x s; p < 0.01) and DR,L (4.9 +/- 2.6 mL x cm H2O x L-1 x s; vs 1.5 +/- 0.8 mL x cm H2O x L-1 x s; p < 0.01); (3) reduced FRC (0.665 +/- 0.191 L vs 1.691 +/- 0.325 L; p < 0.01); (4) increased work performed to inflate both the lung (0.91 +/- 0.25 J/L vs 0.34 +/- 0.08 J/L; p < 0.01) and the chest wall (0.39 +/- 0.13 J/L vs 0.18 +/- 0.04 J/L; p < 0.01); and (5) a reduced pulmonary oxygenation index (PaO2/PAO2 ratio).


CONCLUSIONS
Sedated-paralyzed morbidly obese patients, compared with normal subjects, are characterized 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.
Istituto di Anestesia e Rianimazione, Universita' di Milano, Milan, Italy.
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P
Pelosi
M
M
Croci
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I
Ravagnan
P
P
Vicardi
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L
Gattinoni
D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D000403:Airway Resistance; D004548:Elasticity; D005260:Female; D005652:Functional Residual Capacity; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008168:Lung / Q000502:physiology*; D008170:Lung Compliance; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000502:physiology; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage*; D009767:Obesity, Morbid / Q000503:physiopathology*; D010101:Oxygen Consumption; D011184:Postoperative Period; D011659:Pulmonary Gas Exchange; D015656:Respiratory Mechanics / Q000502:physiology*; D013909:Thorax / Q000502:physiology*; D014783:Viscosity; D014939:Work of Breathing
D006993:Hypnotics and Sedatives; D009466:Neuromuscular Blocking Agents