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• W2323628085 abstract "Editor—The correct setting of mechanical ventilation (MV) during general anaesthesia is actually a source of research and debate,1Levin MA McCormick PJ Lin HM Hosseinian L Fischer GW Low intraoperative tidal volume ventilation with minimal PEEP is associated with increased mortality.Br J Anaesth. 2014; 113: 97-108Abstract Full Text Full Text PDF PubMed Scopus (130) Google Scholar and different ventilation modalities are used in daily practice.2Hemmes SN Gama de Abreu M Pelosi P Schultz MJ High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial.Lancet. 2014; 384: 495-503Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar Moreover, recent trials have compared different modalities of ventilation in terms of volumes and pressures regardless of oxygen concentration in the delivered fresh gases.3Sutherasan Y Vargas M Pelosi P Protective mechanical ventilation in the non-injured lung: review and meta-analysis.Crit Care. 2014; 18: 211Crossref PubMed Scopus (90) Google Scholar Radicals of oxygen species (ROS) production is considered one of the major mechanisms, though oxygen toxicity occurs at a cellular level.4Nathan C Cunningham-Bussel A Beyond oxidative stress: an immunologist's guide to reactive oxygen species.Nat Rev Immunol. 2013; 13: 349-361Crossref PubMed Scopus (951) Google Scholar We recently conducted a pilot, observational study (Careggi Teaching Hospital, Florence, IT), in which we compared, in peripheral blood, the intracellular ROS production, lipoperoxidation (LP), mithocondrial polarization (ΔΨm) and oxygen radical antioxidant capacity (ORAC) in patients undergoing elective robot- assisted prostatectomy. The institutional Ethics Committee approved the study and informed consent from patients was obtained. The two ventilation techniques used in the study (part of daily anaesthesiology practice) were the following: 1.Standard Ventilation (SV): •Volume controlled ventilation with tidal volume of 10 ml/Kg of ideal body weight•PEEP of 4 cm H2O•Fio2 0.5•Respiratory rate set to keep Paco2 between 4.6 and 6.0 kPa2.Protective ventilation with the lowest fraction of inspired oxygen (Fio2) to keep Spo2≥95%; (PVLO2): •Volume controlled ventilation with tidal volume of 10 ml/Kg of ideal body weight•PEEP of 8 cm H2O•Recruiter manoeuvres performed after tracheal intubation, every 60 min, and before extubation maintaining a continuous positive pressure of 30 cm H2O for 30 s•The lowest value of Fio2 to keep Spo2≥95%•Respiratory rate to maintain Paco2 between 4.6 and 6.0 kPa Patient’s venous blood samples were obtained by conventional clinical procedure using EDTA as anticoagulant at four time points: preoperative (T0), end of surgery (T1), 24 h after surgery (T2) and 48 h after surgery (T3). A total of four patients, age 60–70 yrs ASA II, were recruited (two for type of ventilation). As shown in Fig. 1, ROS production and LP were higher in the SV, compared with PVLO2 patients, at all time points except before the induction of anaesthesia. ΔΨm appeared increased 24 h after surgery in the PVLO2 patients, and it returned to the baseline 48 h after surgery. To the best of our knowledge, this is the first attempt to investigate ROS production and their effects in two different ventilation settings. Data shown are indicative of a different systemic reaction to the oxygen species production, even if the limitations are evident and conclusions would be speculative. Nevertheless, the difference in oxidative stress showed using different ventilation settings is very intriguing, and it needs, in our opinion, to be further studied. None declared." @default.
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• W2323628085 date "2015-07-01" @default.
• W2323628085 modified "2023-09-30" @default.
• W2323628085 title "Protective ventilation with low fraction of inspired oxygen and radicals of oxygen production during general anaesthesia" @default.
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• W2323628085 doi "https://doi.org/10.1093/bja/aev180" @default.
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