Intraoperative protective ventilation in patients undergoing major neurosurgical interventions: a randomized clinical trial

BMC Anesthesiology

Federico Longhini¹  Eugenio Garofalo¹  Corrado Pelaia¹  Andrea Bruni¹  Fabrizio Dellapiazza²  Laura Pasin³  Paolo Navalesi⁴  Valentina Rondi⁵  Petra Konrad⁵  Claudia Montagnini⁵  Gianmaria Cammarota⁵  Rosanna Vaschetto⁵  Paolo Murabito⁶  Marcus J. Schultz⁷ 

[1] Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro, Italy;Anesthesia and Intensive Care, Sant’Andrea Hospital, ASL VC, Vercelli, Italy;Anesthesia and Intensive Care, University Hospital of Padua, Via Giustiniani 2, Padova, Italy;Anesthesia and Intensive Care, University Hospital of Padua, Via Giustiniani 2, Padova, Italy;Anesthesiology and Intensive Care Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy;Anesthesia and Intensive Care, “Maggiore Della Carità” Hospital, Novara, Italy;Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy;Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands;Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Amsterdam, The Netherlands;

关键词: Mechanical ventilation;    Postoperative pulmonary complications;    Neurosurgery;   

DOI  :  10.1186/s12871-021-01404-8

来源: Springer

【 摘 要 】

BackgroundPost-operative pulmonary complications (PPC) can develop in up to 13% of patients undergoing neurosurgical procedures and may adversely affect clinical outcome. The use of intraoperative lung protective ventilation (LPV) strategies, usually including the use of a low Vt, low PEEP and low plateau pressure, seem to reduce the risk of PPC and are strongly recommended in almost all surgical procedures. Nonetheless, feasibility of LPV strategies in neurosurgical patients are still debated because the use of low Vt during LPV might result in hypercapnia with detrimental effects on cerebrovascular physiology. Aim of our study was to determine whether LPV strategies would be feasible compared with a control group in adult patients undergoing cranial or spinal surgery.MethodsThis single-centre, pilot randomized clinical trial was conducted at the University Hospital “Maggiore della Carità” (Novara, Italy). Adult patients undergoing major cerebral or spinal neurosurgical interventions with risk index for pulmonary post-operative complications > 2 and not expected to need post-operative intensive care unit (ICU) admission were considered eligible. Patients were randomly assigned to either LPV (Vt = 6 ml/kg of ideal body weight (IBW), respiratory rate initially set at 16 breaths/min, PEEP at 5 cmH2O and application of a recruitment manoeuvre (RM) immediately after intubation and at every disconnection from the ventilator) or control treatment (Vt = 10 ml/kg of IBW, respiratory rate initially set at 6–8 breaths/min, no PEEP and no RM). Primary outcomes of the study were intraoperative adverse events, the level of cerebral tension at dura opening and the intraoperative control of PaCO2. Secondary outcomes were the rate of pulmonary and extrapulmonary complications, the number of unplanned ICU admissions, ICU and hospital lengths of stay and mortality.ResultsA total of 60 patients, 30 for each group, were randomized. During brain surgery, the number of episodes of intraoperative hypercapnia and grade of cerebral tension were similar between patients randomized to receive control or LPV strategies. No difference in the rate of intraoperative adverse events was found between groups. The rate of postoperative pulmonary and extrapulmonary complications and major clinical outcomes were similar between groups.ConclusionsLPV strategies in patients undergoing major neurosurgical intervention are feasible. Larger clinical trials are needed to assess their role in postoperative clinical outcome improvements.Trial registrationregistered on the Australian New Zealand Clinical Trial Registry (www.anzctr.org.au), registration number ACTRN12615000707561.

【 授权许可】

CC BY