Breathing Mechanics, Dead Space and Gas Exchange in the Extremely Obese, Breathing Spontaneously and During Anaesthesia with Intermittent Positive Pressure Ventilation

死区 医学 麻醉 通风(建筑) 潮气量 经肺压 全身麻醉 呼吸 动脉血 呼吸生理学 机械通风 肺容积 呼吸系统 内科学 工程类 机械工程
作者
Göran Hedenstierna,J. Santesson
出处
期刊:Acta Anaesthesiologica Scandinavica [Wiley]
卷期号:20 (3): 248-254 被引量:131
标识
DOI:10.1111/j.1399-6576.1976.tb05036.x
摘要

Breathing mechanics and gas exchange were studied in 10 extremely obese subjects (average weight 138 kg) prior to and during anaesthesia with mechanical ventilation. Breathing mechanics were analysed from measurements of transpulmonary pressure (during anaesthesia, trans‐chest wall pressure as well) inspiratory gas flow and tidal volume. Gas exchange was studied by analysing inspired and expired gas as well as arterial blood samples. The total dead space was deduced from the Bohr equation, and the division into anatomical and alveolar dead space was arrived at by capnography. The patients were anaesthetised with neurolept agents and ventilated with an air‐oxygen mixture. Lung compliance during spontaneous breathing was below normal and decreased further during artificial ventilation. Chest wall compliance measured during anaesthesia was within normal limits. Lung resistance was above normal during spontaneous breathing and increased further during mechanical ventilation. Total dead space was normal during spontaneous breathing and increased moderately during artificial ventilation, the increment coming mainly from alveolar dead space. A moderate hypoxaemia was recorded during spontaneous breathing, and the alveolar‐arterial oxygen tension difference was slightly elevated. During anaesthesia this difference was markedly greater. It is concluded that the most probable reason for the relative hypoxaemia is right‐to‐left shunting.
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