The optimal PEEP after alveolar recruitment maneuver assessed by electrical impedance tomography in healthy horses.
Authors: Andrade Felipe Silveira Rego Monteiro, Ambrósio Aline Magalhães, Rodrigues Renata Ramos, Faccó Lara Lopes, Gonçalves Lucas Alaião, Garcia Filho Sérgio Grandisoli, Dos Santos Rosana Thurler, Rossetto Thais Colombo, Pereira Marco Aurélio Amador, Fantoni Denise Tabacchi
Journal: Frontiers in veterinary science
Summary
# Editorial Summary: Optimal PEEP Management in Equine Anaesthesia Electrical impedance tomography (EIT) offers real-time visualisation of lung aeration changes during anaesthesia, enabling clinicians to identify and reverse atelectasis through recruitment manoeuvres—but determining the optimal positive end-expiratory pressure (PEEP) to maintain alveolar patency afterwards remains poorly defined in equine practice. Monteiro and colleagues used EIT monitoring in healthy anaesthetised horses to systematically assess which PEEP level best preserves lung recruitment after performing a standardised alveolar recruitment manoeuvre, measuring regional ventilation changes across different pressure settings. The research identified specific PEEP thresholds that maintain maximal alveolar opening whilst minimising overdistension in horses, with findings distinct from human and canine protocols currently extrapolated to equine patients. These results have direct relevance for anaesthetists managing large animal cases, particularly lengthy procedures where ventilation-induced lung injury poses significant recovery risks, as individualised PEEP titration based on EIT guidance could reduce post-operative pulmonary complications and improve oxygenation outcomes. Farriers and stable managers should recognise that horses recovering from general anaesthesia may benefit from improved ventilation management, potentially reducing post-operative complications that affect athletic soundness and respiratory function.
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Practical Takeaways
- •EIT can guide anesthetists to set individualized PEEP levels that prevent alveolar collapse while avoiding overdistension, improving oxygenation outcomes in equine surgery
- •Use EIT during induction and recovery from general anesthesia to monitor lung recruitment status and adjust ventilation parameters in real time for high-risk cases
- •Consider EIT assessment for horses requiring prolonged anesthesia or those with pre-existing respiratory compromise to optimize mechanical ventilation strategy
Key Findings
- •Electrical impedance tomography (EIT) is an effective non-invasive tool for assessing pulmonary aeration and guiding optimal PEEP selection in anesthetized horses undergoing alveolar recruitment maneuvers
- •EIT allows real-time visualization of lung ventilation distribution and identification of atelectatic regions, enabling individualized PEEP titration to maintain alveolar recruitment
- •The technique provides similar diagnostic utility in horses as previously demonstrated in humans and dogs for assessing pulmonary function during anesthesia and mechanical ventilation