Perioperative Positive Pressure Ventilation

Futier, Emmanuel; Marret, Emmanuel; Jaber, Samir

doi:10.1097/aln.0000000000000335

Cited by 90 publications

(21 citation statements)

References 32 publications

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“…We can look forward to the results of the PROBESE trial, which will provide additional insight into the potential benefit of higher PEEP and recruitment maneuvers in obese patients at moderate risk for development of PPCs (NCT02148692). Lastly, as the mechanical ventilators used intraoperatively become more nuanced and access to NIPPV increases, integrated strategies involving perioperative lung protective ventilation such as those used in the iPROVE trial may expand our capabilities to prevent postoperative atelectasis and the risk of PPCs that comes with it 90129…”

Section: Resultsmentioning

confidence: 99%

Perioperative lung protective ventilation

O’Gara

Talmor

2018

BMJ

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Perioperative lung injury is a major source of postoperative morbidity, excess healthcare use, and avoidable mortality. Many potential inciting factors can lead to this condition, including intraoperative ventilator induced lung injury. Questions exist as to whether protective ventilation strategies used in the intensive care unit for patients with acute respiratory distress syndrome are equally beneficial for surgical patients, most of whom do not present with any pre-existing lung pathology. Studied both individually and in combination as a package of intraoperative lung protective ventilation, the use of low tidal volumes, moderate positive end expiratory pressure, and recruitment maneuvers have been shown to improve oxygenation and pulmonary physiology and to reduce postoperative pulmonary complications in at risk patient groups. Further work is needed to define the potential contributions of alternative ventilator strategies, limiting excessive intraoperative oxygen supplementation, use of non-invasive techniques in the postoperative period, and personalized mechanical ventilation. Although the weight of evidence strongly suggests a role for lung protective ventilation in moderate risk patient groups, definitive evidence of its benefit for the general surgical population does not exist. However, given the shift in understanding of what is needed for adequate oxygenation and ventilation under anesthesia, the largely historical arguments against the use of intraoperative lung protective ventilation may soon be outdated, on the basis of its expanding track record of safety and efficacy in multiple settings.

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Section: Resultsmentioning

confidence: 99%

Perioperative lung protective ventilation

O’Gara

Talmor

2018

BMJ

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“…An observational study conducted in 28 centers in France revealed that most patients undergoing general surgery, including obese patients, were ventilated with low PEEP (≤4 cmH 2 O) or even without PEEP, even though average PEEP was higher in obese than in nonobese patients [11]. In fact, current recommendations on the use of PEEP and RMs [4, 12] are derived from trials that included mainly patients with BMI <35 kg/m 2 and therefore cannot be extrapolated to obese patients.…”

Section: Introductionmentioning

confidence: 99%

Protective intraoperative ventilation with higher versus lower levels of positive end-expiratory pressure in obese patients (PROBESE): study protocol for a randomized controlled trial

Bluth¹,

Teichmann²,

Kiss³

et al. 2017

Trials

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BackgroundPostoperative pulmonary complications (PPCs) increase the morbidity and mortality of surgery in obese patients. High levels of positive end-expiratory pressure (PEEP) with lung recruitment maneuvers may improve intraoperative respiratory function, but they can also compromise hemodynamics, and the effects on PPCs are uncertain. We hypothesized that intraoperative mechanical ventilation using high PEEP with periodic recruitment maneuvers, as compared with low PEEP without recruitment maneuvers, prevents PPCs in obese patients.Methods/designThe PRotective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in OBESE Patients (PROBESE) study is a multicenter, two-arm, international randomized controlled trial. In total, 2013 obese patients with body mass index ≥35 kg/m2 scheduled for at least 2 h of surgery under general anesthesia and at intermediate to high risk for PPCs will be included. Patients are ventilated intraoperatively with a low tidal volume of 7 ml/kg (predicted body weight) and randomly assigned to PEEP of 12 cmH2O with lung recruitment maneuvers (high PEEP) or PEEP of 4 cmH2O without recruitment maneuvers (low PEEP). The occurrence of PPCs will be recorded as collapsed composite of single adverse pulmonary events and represents the primary endpoint.DiscussionTo our knowledge, the PROBESE trial is the first multicenter, international randomized controlled trial to compare the effects of two different levels of intraoperative PEEP during protective low tidal volume ventilation on PPCs in obese patients. The results of the PROBESE trial will support anesthesiologists in their decision to choose a certain PEEP level during general anesthesia for surgery in obese patients in an attempt to prevent PPCs.Trial registrationClinicalTrials.gov identifier: NCT02148692. Registered on 23 May 2014; last updated 7 June 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1929-0) contains supplementary material, which is available to authorized users.

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“…Tsai et al [ 5 ] evaluated shoulder, upper abdominal, and lower abdominal pain, and obtained results similar to ours. Furthermore the use of a PRM in combination with low tidal volumes (6–8 mL/kg) and PEEP, is referred to as lung-protective ventilation, and is associated with improved clinical outcomes, such as a reduction of mortality after abdominal surgery [ 22 ]. However, our study has only focused on PRM, therefore tidal volumes of 7–9 mL/kg without PEEP were applied.…”

Section: Discussionmentioning

confidence: 99%

Effect of the pulmonary recruitment maneuver on pain after laparoscopic gynecological oncologic surgery: a prospective randomized trial

2018

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ObjectiveTo evaluate the effectiveness of the pulmonary recruitment maneuver (PRM) at the end of the operation to decrease laparoscopy-induced abdominal or shoulder pain after gynecological oncologic surgery.MethodsIn total, 113 women undergoing laparoscopic surgery for malignant or premalignant gynecological lesions were assigned randomly to two groups: the PRM group (the patient was placed in the Trendelenburg position (30°) and the PRM, consisting of two manual pulmonary inflations to a maximum pressure of 40 cmH2O) (n=54) and the control group (n=52). Postoperative shoulder and abdominal pain was assessed 12, 24, and 48 hours later using a visual analog scale (0–10). In addition, the incidence of post-discharge nausea and vomiting was recorded until 48 hours after discharge.ResultsPostoperative shoulder pain at 12 and 24 hours was significantly less severe in the PRM group (2.2±0.5 and 2.0±0.4) than in the control group (4.0±0.5 and 3.9±0.4; both p<0.001). The PRM significantly reduced the severity of upper abdominal pain at 12 and 24 h compared with the control group (3.1±0.4 and 2.9±0.4 vs. 5.9±0.5 and 4.9±0.5; both p<0.001). The analgesic requirement during the postoperative period was similar in the two groups (control group, 78.8%; PRM group, 75.9%; p=0.719).ConclusionThe PRM effectively and safely reduced postoperative shoulder and upper abdominal pain levels in patients undergoing laparoscopic gynecological oncologic surgery. Trial registry at ClinicalTrials.gov, NCT01940042.

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Perioperative Positive Pressure Ventilation

Abstract: Postoperative pulmonary complications are a major cause of postoperative morbidity and mortality. The perioperative positive pressure ventilation bundle could help at further reducing postoperative pulmonary complications.

Cited by 90 publications

References 32 publications

Perioperative lung protective ventilation

Perioperative lung protective ventilation

Protective intraoperative ventilation with higher versus lower levels of positive end-expiratory pressure in obese patients (PROBESE): study protocol for a randomized controlled trial

Effect of the pulmonary recruitment maneuver on pain after laparoscopic gynecological oncologic surgery: a prospective randomized trial

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