Literature Review : Hubungan Obesitas dengan Kejadian Asma

Asthma can be worsened by obesity because obesity can cause a decrease in the pulmonary compliance system, lung volume, and airway diameter. Therefore, it is necessary to maintain an ideal body weight to prevent obesity and the incidence of asthma.The purpose of this literature review study was to describe the correlation between obesity and the incidence of asthma.This research used the Google Scholar database, Garuda Portal and PUBMED. The keywords used in searching for articles on the Google Scholar database and Garuda Portal were “obesity” and “asma”, while on PUBMED ere “obesity and asthma”.The results of a literature review of 5 article showed that there was a correlation between obesity and the incidence of asthma.The conclusion from this study showed that the result of obesity and asthma was 52% and the result from the “non-overweighted but have asthma” respondent was 48%. The p-value was less than 0,005. It means that the p-value is smaller. Therefore, it can be concluded that there is a correlation between obesity and the incidence of asthma. Keywords : Asthma, Obesity AbstrakAsma dapat diperburuk dengan adanya obesitas disamping itu obesitas dapat menyebabkan penurunan sistem komplians paru, volume paru dan diameter saluran napas. Oleh karena itu harus menjaga berat badan agar tetap ideal supaya tidak terjadi obesitas dan kejadian asma. Tujuan dari penelitian literature review ini adalah untuk mengetahui apakah ada hubungan obesitas dengan kejadian asma.Penelitian ini menggunakan database Google Schoolar, Portal Garuda dan PUBMED. Untuk database Google Schoolar dan Portal Garuda menggunakan kata kunci “obesitas dan asma” sedangkan pada PUBMED menggunakan kata kunci “obesity and asthma”.Hasil literature review dari 5 artikel didapatkan bahwa adanya hubungan antara obesitas dengan kejadian asma.Simpulan dari penelitian literature review ini menunjukan hasil obesitas dan asma sebanyak 52% serta hasil tidak obesitas tetapi mengalami asma sebanyak 48% dan nilai p value menghasilkan < 0,005 yang bearti nilai p value lebih kecil. Jadi dapat disimpulkan adanya hubungan antara obesitas dengan kejadian asma. Kata kunci : Asma, Obesitas

Evaluation of the influence of individualized protective ventilation on the lung mechanical properties

The work is devoted to the study of the influence of individualized protective ventilation support on pulmonary mecha-nics. The study included 47 patients who underwent open abdominal surgery under general anesthesia. All patients had a moderate to high risk of developing postoperative pulmonary complications by the ARISCAT scale. Intraoperatively, the impact of individualized protective ventilation on respiratory mechanics, namely Ppeak, Pplat, Pdrive, dynamic pulmonary compliance was assessed. Individualized protective respiratory support was ventilation with a tidal volume of 7 ml/kg of ideal body weight, with the selection of the optimal level of positive pressure at the end of exhalation (PEEP), focusing on dynamic pulmonary compliance and performing recruiting maneuver, and then in the case of a decrease in dynamic pulmonary compliance by more than 20 %, followed by re-selection of PEEP. The studied parameters were recorded before and after the recruiting maneuver, as well as on the 30th, 60th, 90th, 120th, 150th, 180th minutes after the recruiting maneuver, depending on the duration of the operation. The use of alveolar straightening techniques led to an improvement in pulmonary mechanics, namely, an increase in dynamic pulmonary compliance by 16 % and a decrease in Pdrive by 17 %. The intraoperative level of PEEP averaged 4 [4; 5] cm of water. No cases of hypoxemia or recurrence of recruiting maneuver were reported. The obtained results indicate that chosen technique of recruiting maneuver is effective and safe, and its use allows reducing the negative impact of mechanical ventilation. The study did not find a statistically significant correlation between the level of PEEP and the value of dynamic pulmonary compliance. Such data prove the need for individual selection of ventilation parameters according to the characteristics of the mechanical properties of each patient.

Cardiorespiratory changes during robotic pelvic surgeries- A prospective observational Study

Robot assisted pelvic surgeries are associated with cardiorespiratory changes due to conjunction of carboperitoneum and steep Trendelenburg position for prolonged durations. To determine the changes in cardiovascular and respiratory systems in patients undergoing elective robot assisted pelvic surgeries under general anesthesia. A prospective observational study was conducted in 35 patients scheduled for elective robot assisted pelvic surgeries. Patients belonging to ASA class I and II were included and their intraoperative hemodynamic and respiratory parameters were noted post induction (baseline), at pneumoperitoneum, at and every 15 minutes after steep Trendelenburg positioning, at resuming supine position, at deflation of pneumoperitoneum and post-deflation. Primary outcome was mean arterial pressure. Secondary outcomes were systolic and diastolic blood pressures, heart rate, central venous pressure, airway pressures (peak, plateau and mean), pulmonary compliance, minute ventilation, end tidal carbondioxide levels and blood gas values. On assuming steep Trendelenburg position, there was significant increase in systolic, mean and diastolic blood pressures. There was significant increase in peak, plateau and mean airway pressures and significant decrease in pulmonary compliance which led to increase in end tidal carbondioxide levels and minute ventilation. On resuming supine position and deflation of pneumoperitoneum, there was significant decrease in mean arterial pressure. Although the pulmonary compliance improved, it continued to be significantly lower than the post-induction baseline value. Robot-assisted pelvic surgeries are associated with significant changes in hemodynamic and respiratory parameters of patients.

Early pulmonary compliance increase during cardiac surgery predicted post-operative lung dysfunction

Introduction: Lung dysfunction following cardiac surgery is currently viewed as the consequence of atelectasis and lung injury. While the mechanism of atelectasis has been largely detailed, the pathogenesis of lung injury after cardiopulmonary bypass is still unclear. Based upon clinical and experimental studies, we hypothesized that lungs could be injured through a mechanical phenomenon. Methods: We recorded pulmonary compliance at six key moments of a heart operation in 62 adult patients undergoing elective cardiac surgery. We focused on the period lasting from anesthetic induction to aorta unclamping. We calculated the variation of static and dynamic pulmonary compliance caused by thorax opening; ΔCstat1 and ΔCdyn1 and that caused by cardiopulmonary bypass, ΔCstat2 and ΔCdyn2. Blood gases were performed under standardized ventilation after anesthetic induction and after surgical closure. The PaO2/FiO2 ratio was calculated. ∆PaO2/FiO2 was the criterion for lung dysfunction. We compared ΔCstat1 and ΔCdyn1 with both ∆PaO2/FiO2 and, respectively, ΔCstat2 and ΔCdyn2. Results: Static and dynamic compliance increased with the opening of the thorax and decreased with the start of cardiopulmonary bypass. The PaO2/FiO2 ratio diminished after surgery. ΔCstat1 and ΔCdyn1 were negatively correlated with both ∆PaO2/FiO2 (r=-0.42; p<0.001 and r=-0.44; p<0.001) and, respectively, with ΔCstat2 and ΔCdyn2 (r=-0.59; p<0.001 and r=-0.53; p<0.001). Conclusions: Increased pulmonary compliance induced by the opening of the thorax is correlated with worsened intrapulmonary shunt after cardiopulmonary bypass. A mechanical phenomenon could be partly responsible for post-operative hypoxemia.