EFFECT OF ADJUSTABLE PRESSURE LIMITING VALVE SETTINGS DURING WEANING WITH GENERAL ANESTHESIA AT DR. MOHAMAD SOEWANDI REGIONAL GENERAL HOSPITAL, SURABAYA
DOI:
https://doi.org/10.61677/jth.v4i2.965Keywords:
Adjustable Pressure Limiting (APL), tidal volume, anesthesia weaning, general anesthesia, endotracheal intubation.Abstract
Adequate ventilation management during the weaning phase of general anesthesia is essential for patient safety. The Adjustable Pressure Limiting (APL) valve regulates pressure within the anesthesia breathing circuit and may influence spontaneous tidal volume (VT). Inappropriate APL settings may contribute to inadequate ventilation, respiratory fatigue, atelectasis, or excessive airway pressure. This study aimed to analyze differences in spontaneous VT among APL valve settings of 10, 20, and 30 cmH₂O during anesthesia weaning in adult patients undergoing general anesthesia with endotracheal intubation. This study used an observational analytical design with a repeated-measures approach. Forty adult patients with ASA physical status I–II were selected using consecutive sampling. Each participant was observed under three APL settings during the weaning phase. Tidal volume was recorded for five consecutive breaths at each setting, and the mean value was used for analysis. Data normality was assessed using the Shapiro-Wilk test. Because the data were not normally distributed, differences among the three APL settings were analyzed using the Friedman test. Mean VT was 247.05 mL at APL 10 cmH₂O, decreased to 219.01 mL at 20 cmH₂O, and further decreased to 200.76 mL at 30 cmH₂O. The Friedman test demonstrated a statistically significant difference in VT among the three APL settings (p < 0.001). Higher APL settings were associated with lower spontaneous VT and increased PIP. These findings suggest that APL adjustment during weaning should be individualized and accompanied by continuous monitoring of ventilation and airway pressure to support safe and adequate spontaneous breathing.
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