• anesthesia;
  • horses;
  • mechanical ventilation;
  • positive end-expiratory pressure;
  • recruitment maneuvers



To assess if positive end-expiratory pressure (PEEP) titration improves gas exchange and respiratory mechanics, without hemodynamic impairment in horses during anesthesia.


Prospective, randomized study.


Thirteen isoflurane-anesthetized healthy horses.


After 60 minutes of anesthesia with spontaneous breathing, mechanical ventilation was initiated with an inspiratory-expiratory ratio of 1:2, PEEP of 5 cmH2O, tidal volume of 10–20 mL kg−1 and respiratory rate adjusted to maintain normocapnia. Constant PEEP of 5 cmH2O was continued (control group; = 6) or titrated (PEEP group; = 7) by increasing and decreasing PEEP from 5 to 20 cmH2O at 15-minute intervals. The horses were instrumented with an arterial catheter to measure blood pressure and allow collection of blood for pH and blood gas analysis and a Swan-Ganz catheter for measurement of cardiac output (CO) using thermodilution. Cardiopulmonary assessment was recorded before PEEP titration and after 15 minutes at each PEEP value.


In the PEEP group, static compliance (range) (Cst 278–463 mL cmH2O−1) was significantly higher and the shunt fraction (inline image 7–20%) and the alveolar-arterial oxygen difference [P(A-a)O2 95–325 mmHg] were significantly lower than in the control group [Cst of 246–290 mL cmH2O−1, inline image of 16–19%, P(A-a)O2 of 253–310 mmHg; < 0.05]. CO (mean ± SEM) was lower in the PEEP group (23 ± 2 L minute−1) at 20 cmH2O PEEP than in the control group (26 ± 4 L minute−1, < 0.05), with no significant changes in heart rate, blood pressure or central venous pressure.


PEEP titration significantly improved gas exchange and lung compliance, with a small decrease in CO at the highest PEEP level.

Clinical relevance

Gas exchange and respiratory mechanics impairment during inhalation anesthesia can be treated using PEEP titration from 5 to 20 cmH2O, without clinically important hemodynamic effects in healthy horses.