Lung-protective mechanical ventilation for patients undergoing abdominal laparoscopic surgeries: a randomized controlled trial

BMC Anesthesiology

Chi Tue Nguyen¹  Trung Kien Nguyen¹  Quang Huy Nguyen¹  Viet Luong Nguyen²  The Anh Vu³  Dang Thu Nguyen³  Duc Hanh Mai³  Ngoc Quynh Nguyen⁴  Truong Giang Nguyen⁵  Anh Nguyet Le⁶ 

[1] Center of Emergency, Critical Care Medicine and Clinical Toxicology, 103 Military Hospital, Vietnam Military Medical University, 261 Phung Hung road, Ha Dong District, Hanoi City, Vietnam;Critical Care Unit, National Burn Hospital, Vietnam Military Medical University, Hanoi, Vietnam;Department of Anesthesia and Pain Medicine, 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam;Department of Anesthesia and Pain Medicine, Vietnam National Cancer Hospital, Hanoi, Vietnam;Department of Cardiothoracic surgery, 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam;Department of Urology, 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam;

关键词: Lung-protective ventilation;    Low tidal volume;    Recruitment maneuvers;    Positive end-expiratory pressure;   

DOI  :  10.1186/s12871-021-01318-5

来源: Springer

【 摘 要 】

BackgroundPneumoperitoneum and Trendelenburg position in laparoscopic surgeries could contribute to postoperative pulmonary dysfunction. In recent years, intraoperative lung-protective mechanical ventilation (LPV) has been reportedly able to attenuate ventilator-induced lung injuries (VILI). Our objectives were to test the hypothesis that LPV could improve intraoperative oxygenation function, pulmonary mechanics and early postoperative atelectasis in laparoscopic surgeries.MethodsIn this randomized controlled clinical trial, 62 patients indicated for elective abdominal laparoscopic surgeries with an expected duration of greater than 2 h were randomly assigned to receive either lung-protective ventilation (LPV) with a tidal volume (Vt) of 7 ml kg− 1 ideal body weight (IBW), 10 cmH2O positive end-expiratory pressure (PEEP) combined with regular recruitment maneuvers (RMs) or conventional ventilation (CV) with a Vt of 10 ml kg− 1 IBW, 0 cmH2O in PEEP and no RMs. The primary endpoints were the changes in the ratio of PaO2 to FiO2 (P/F). The secondary endpoints were the differences between the two groups in PaO2, alveolar-arterial oxygen gradient (A-aO2), intraoperative pulmonary mechanics and the incidence of atelectasis detected on chest x-ray on the first postoperative day.ResultsIn comparison to CV group, the intraoperative P/F and PaO2 in LPV group were significantly higher while the intraoperative A-aO2 was clearly lower. Cdyn and Cstat at all the intraoperative time points in LPV group were significantly higher compared to CV group (p < 0.05). There were no differences in the incidence of atelectasis on day one after surgery between the two groups.ConclusionsLung protective mechanical ventilation significantly improved intraoperative pulmonary oxygenation function and pulmonary compliance in patients experiencing various abdominal laparoscopic surgeries, but it could not ameliorate early postoperative atelectasis and oxygenation function on the first day after surgery.Trial registrationhttps://www.clinicaltrials.gov/identifier: NCT04546932 (09/05/2020).

【 授权许可】

CC BY