@phdthesis{Opitz2021,
  author    = {Opitz, Anne},
  title     = {Postoperative Ver{\"a}nderung der regionalen Ventilation bei Spontanatmung nach Eingriffen an den Extremit{\"a}ten in Allgemeinan{\"a}sthesie},
  doi       = {10.25972/OPUS-22469},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-224692},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2021},
  abstract  = {Postoperative pulmonale Komplikationen (PPK) geh{\"o}ren zu den h{\"a}ufigsten Ursachen, die zu einem verl{\"a}ngerten Krankenhausaufenthalt, steigenden Kosten und einer erh{\"o}hten Morbidit{\"a}t und Mortalit{\"a}t f{\"u}hren. Die pulmonale elektrische Impedanztomographie (EIT) erm{\"o}glicht die bettseitige Visualisierung der regionalen Lungenventilation in Echtzeit in der transversalen Elektrodenebene. Insbesondere dorsale Atelektasen oder Pleuraerg{\"u}sse k{\"o}nnen eine Verschiebung der Ventilation nach ventral bewirken. Als Hypothese wurde angenommen, dass postoperativ bei spontanatmenden Patienten nach einem peripheren Eingriff eine Umverteilung der Ventilation nach ventral auftritt und dadurch die Vitalkapazit{\"a}t der Lunge abnimmt. In die prospektive Beobachtungstudie wurden 27 Patienten eingeschlossen, die sich einem elektiven peripheren Eingriff in Allgemeinnarkose (mit oder ohne Regionalan{\"a}sthesie) unterzogen und ein erh{\"o}htes Risiko f{\"u}r PPK's aufwiesen. Die Lungenfunktion der Patienten wurde pr{\"a}operativ sowie am ersten und dritten postoperativen Tag mittels EIT in Spontanatmung und einem forcierten Atemman{\"o}ver erfasst. Dabei wurde das Center of Ventilation (COVy) berechnet. Periphere Eingriffe in Allgemeinnarkose f{\"u}hrten nicht zu einer signifikanten ventralen Verschiebung der regionalen pulmonalen Ventilation in Spontanatmung gem{\"a}ß pulmonalem EIT am ersten und dritten postoperativen Tag. Die FVC\%Soll war lediglich am ersten postoperativen Tag vermindert. Bei zwei Patienten traten postoperative pulmonale Komplikationen auf. Insgesamt zeigte die Kohorte nur geringe Ver{\"a}nderungen der Vitalkapazit{\"a}t, was einen Einfluss der Eingriffslokalisation auf die Umverteilung der pulmonalen Ventilation nahelegt.},
  subject      = {Lungenfunktion},
  language  = {de}
}
@article{BauerOpitzFilseretal.2019,
  author    = {Bauer, Maria and Opitz, Anne and Filser, J{\"o}rg and Jansen, Hendrik and Meffert, Rainer H. and Germer, Christoph T. and Roewer, Norbert and Muellenbach, Ralf M. and Kredel, Markus},
  title     = {Perioperative redistribution of regional ventilation and pulmonary function: a prospective observational study in two cohorts of patients at risk for postoperative pulmonary complications},
  series = {BMC Anesthesiology},
  volume    = {19},
  journal   = {BMC Anesthesiology},
  doi       = {10.1186/s12871-019-0805-8},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-200730},
  pages     = {132},
  year      = {2019},
  abstract  = {Background Postoperative pulmonary complications (PPCs) increase morbidity and mortality of surgical patients, duration of hospital stay and costs. Postoperative atelectasis of dorsal lung regions as a common PPC has been described before, but its clinical relevance is insufficiently examined. Pulmonary electrical impedance tomography (EIT) enables the bedside visualization of regional ventilation in real-time within a transversal section of the lung. Dorsal atelectasis or effusions might cause a ventral redistribution of ventilation. We hypothesized the existence of ventral redistribution in spontaneously breathing patients during their recovery from abdominal and peripheral surgery and that vital capacity is reduced if regional ventilation shifts to ventral lung regions. Methods This prospective observational study included 69 adult patients undergoing elective surgery with an expected intermediate or high risk for PPCs. Patients undergoing abdominal and peripheral surgery were recruited to obtain groups of equal size. Patients received general anesthesia with and without additional regional anesthesia. On the preoperative, the first and the third postoperative day, EIT was performed at rest and during spirometry (forced breathing). The center of ventilation in dorso-ventral direction (COVy) was calculated. Results Both groups received intraoperative low tidal volume ventilation. Postoperative ventral redistribution of ventilation (forced breathing COVy; preoperative: 16.5 (16.0-17.3); first day: 17.8 (16.9-18.2), p < 0.004; third day: 17.4 (16.2-18.2), p = 0.020) and decreased forced vital capacity in percentage of predicted values (FVC\%predicted) (median: 93, 58, 64\%, respectively) persisted after abdominal surgery. In addition, dorsal to ventral shift was associated with a decrease of the FVC\%predicted on the third postoperative day (r = - 0.66; p < 0.001). A redistribution of pulmonary ventilation was not observed after peripheral surgery. FVC\%predicted was only decreased on the first postoperative day (median FVC\%predicted on the preoperative, first and third day: 85, 81 and 88\%, respectively). In ten patients occurred pulmonary complications after abdominal surgery also in two patients after peripheral surgery. Conclusions After abdominal surgery ventral redistribution of ventilation persisted up to the third postoperative day and was associated with decreased vital capacity. The peripheral surgery group showed only minor changes in vital capacity, suggesting a role of the location of surgery for postoperative redistribution of pulmonary ventilation.},
  language  = {en}
}