Severinghaus Lecture: No two lungs are alike

Jeanine P. Wiener-Kronish, M.D., understands physiology from bench to bedside to operating table. For 11 years, she’s been Chair of Anesthesia, Critical Care and Pain Medicine at Massachusetts General Hospital. But she also spent 35 years doing clinical research.

Jeanine P. Wiener-Kronish, M.D.

Dr. Wiener-Kronish will call on her vast array of expertise when she delivers Tuesday’s John W. Severinghaus Lecture on Translational Science. Specifically, she will share recent scientific discoveries that are changing the way anesthesiologists ventilate patients in the O.R. and ICU.

“Anesthesiologists are master physiologists and experts with mechanical ventilators. These superpowers can help us protect our patients and expand the role of anesthesia,” Dr. Wiener-Kronish said.

John W. Severinghaus Lecture on Translational Science: Personalized PEEP

11 a.m. – 12 p.m.

W320 Chapin Theater

During the lecture, Dr. Wiener-Kronish is expected to outline the history of mechanical ventilation settings as well as new practices that are being explored. According to Dr. Wiener-Kronish, using the same recipe for every patient on a mechanical ventilator is no longer adequate.

Research has revealed that even genetically identical animals experience different lung responses. The same is true with humans. The National Academy of Medicine’s most recent publication is on caring for the individual patient.

“There is incredible variability from patient to patient, even among healthy individuals. During treatment, we need to take a multitude of factors into consideration, including age, size, lung disease and operating conditions,” she said.

Over the last 40 years, anesthesiologists have done their best to address the diverse needs of patients. Today, advanced tools provide significant opportunity for personalization. Tailoring positive end-expiratory pressure (PEEP) to each patient is possible.

Dr. Wiener-Kronish will discuss several modern imaging techniques designed to help anesthesiologists assess the levels of atelectasis at the bedside to determine the optimal PEEP. They include ultrasound, esophageal manometry and EIT. Some techniques may be more appropriate for research, including PET scans with radioactive markers and hyperpolarized gases utilized in MRI scanning.

At Massachusetts General Hospital, Dr. Wiener-Kronish has enjoyed learning first-hand about scientific breakthroughs from two prominent anesthesia investigators in her department: Lorenzo Berra, M.D., and Marcos F. Vidal Melo, M.D., Ph.D.

“As an intensive care physician, I use their tools all the time,” she said. “Acquiring new tools and education is essential for the optimal care of our patients. What we learn today has an expiration date.”

While personalized PEEP benefits all patients, it’s indispensable in the treatment of obese patients. The latest estimates reveal nearly 40% of American adults meet the criteria for obesity. Dr. Wiener-Kronish believes anesthesiologists must prepare for bigger patients with smaller lungs.

For example, during laparoscopic and robotic surgeries, gas added to the abdomen pushes the lungs up, making them smaller. In robotic surgeries, the head-down position of the patient makes the lungs even smaller.

“If the patient receiving robotic surgery happens to be obese, this is a life-threatening activity,” she said.

Dr. Wiener-Kronish will show that with enhanced visualization tools, anesthesiologists can actually increase the available lung. They can locate areas that have collapsed and expand them. They can create –  and improve – homogenous ventilation.

“I’m optimistic about the future of anesthesia,” said Dr. Wiener-Kronish. “We have much more information available to us these days. We need to utilize that data to take better care of our patients of all shapes and sizes.”

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