Master of Science in Nursing (MSN)
School of Nursing
There are many pathophysiologic health effects associated with obesity, and the effects on normal respiratory physiology can be profound. The presence of increased adipose tissue can limit a patient’s functional residual capacity, reduce end expiratory lung volumes, and increase small airway closure. When exposed to general anesthesia with mechanical ventilation these physiologic changes can increase atelectasis development and increase the likelihood of ventilation-perfusion mismatching. Alveolar recruitment maneuvers are brief applications of positive airway pressure that are employed to recruit alveoli that have already collapsed and prevent new atelectasis formation. The purpose of this systematic review was to determine if the use of alveolar recruitment maneuvers are a safe and effective treatment strategy for managing the adult obese patient requiring general anesthesia with mechanical ventilation. The theoretical framework that guided this systematic review was the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Randomized control trials that utilized alveolar recruitment maneuvers in adult obese patients were reviewed and appraised for inclusion in this systematic review. It was determined that alveolar recruitment maneuvers are a safe and effective strategy for minimizing atelectasis development in the adult obese patient undergoing general anesthesia. Alveolar recruitment maneuvers were associated with an improved intraoperative oxygenation, a decreased alveolar-arterial oxygen concentration gradient, and improved lung compliance. Furthermore, alveolar recruitment maneuver use demonstrated a decrease in atelectasis development measured via computed tomography and radiograph imaging. Application of these maneuvers in the obese patient during the perioperative period can improve ventilation-perfusion matching and decrease respiratory complications associated with atelectasis development.
Banks, Joseph A., "Efficacy of Alveolar Recruitment Maneuvers in the Adult Obese Patient Undergoing General Anesthesia: A Systematic Review of the Literature" (2018). Master's Theses, Dissertations, Graduate Research and Major Papers Overview. 291.
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