Anaes Cases · Anaesthetic ventilators
Ventilating the morbidly obese patient for abdominal surgery
The long case — the morbidly obese patient has a low chest-wall and lung compliance, a low functional residual capacity, and a high driving-pressure risk. The lung-protective ventilation on the predicted body weight, the PEEP, the pressure-controlled or the adaptive mode, and the recruitment manoeuvres are the principles.
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Prompt
A 48-year-old woman, 130 kg (BMI 45), for a three-hour laparoscopic gastric bypass. Discuss the choice of the ventilator mode and the lung-protective settings, and how you would manage the airway pressures and the oxygenation.
Presentation
A 48-year-old woman, 130 kg, BMI 45, for a three-hour laparoscopic Roux-en-Y gastric bypass. She has well-controlled hypertension and diet-controlled diabetes. She desaturates rapidly on lying flat. Discuss the ventilation strategy: the mode, the tidal volume, the PEEP, and the management of the high airway pressures.
References3ShowHide
- [5]Neto AS, et al. Association between driving pressure and postoperative pulmonary complications. Lancet Respir Med, 2016.PMID 26947624
- [6]Severgnini P, et al. Protective ventilation during general anesthesia. Anesthesiology, 2013.PMID 23542800
- [26947625]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.