Application of alveolar recruitment strategy and positive end-expiratory pressure combined with autoflow in the one-lung ventilation during thoracic surgery in obese patients

Zhiguo, Shi; Geng, Wei; Gao, Guang-kuo; Wang, Chun; Liu, Wei

doi:10.21037/jtd.2019.01.41

Cited by 7 publications

(6 citation statements)

References 29 publications

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“…Overall, the other indexes included in multivariate analysis were also not associated with the treatment rate of ICU related to pneumonia (P > 0.05). The current preventive measures for these complications include optimization of preoperative complications, smoking cessation, correction of anemia, preoperative breathing training, and intraoperative protective lung ventilation strategies among others [15,25,[33][34][35]. Clinical administration of the prophylactic aerosol is aimed at assisting expectoration patients.…”

Section: Baseline and Clinical Characteristics Of The Patientsmentioning

confidence: 99%

Effectiveness of aerosol therapy on prevention and treatment of postoperative pulmonary complications of gastric cancer: a cross-sectional study based on a patients’ registry

Bai

Zhao

Wen

et al. 2023

Preprint

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Purpose Postoperative aerosol therapy is a common clinical intervention after general anesthesia that is aimed at preventing postoperative pulmonary complications (PPCs). However, few studies have evaluated its effectiveness. We evaluated the effectiveness of aerosol therapy on the prevention and treatment of PPCs in gastric cancer patients. Methods This cross-sectional study (consecutive case series) was based on the surgical gastric cancer patient registry at West China Hospital. The included cases were retrospectively evaluated. Between January 2016 and December 2018, 1087 patients with pathologically confirmed gastric adenocarcinoma, and who had been subjected to radical surgery were enrolled in this study. These patients were assigned into two groups, the prophylactic aerosol group and the non-prophylactic aerosol group. Risk factors and intervention measures for PPCs were compared. Among the 1087 patients, a total of 235 patients with PPCs and who had not received prophylactic aerosol therapy were enrolled in the therapeutic aerosol therapy subgroup. We determined whether therapeutic aerosol therapy could improve perioperative outcomes for gastric cancer patients with PPCs. Results There were no differences in PPCs incidences between gastric cancer patients administered with prophylactic aerosol (37.5%) and those without prophylactic aerosol administration (39.4%) (p = 0.510). Univariate analysis revealed that prophylactic aerosol therapy was not a protective against PPCs after gastric cancer surgery (p = 0.510). Multivariate analysis showed that there was no correlation between prophylactic aerosol therapy and PPCs (p = 0.894). Conclusions Postoperative aerosol therapy was not effective in the prevention or control of PPCs in gastric cancer patients.

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Section: Baseline and Clinical Characteristics Of The Patientsmentioning

confidence: 99%

Effectiveness of aerosol therapy on prevention and treatment of postoperative pulmonary complications of gastric cancer: a cross-sectional study based on a patients’ registry

Bai

Zhao

Wen

et al. 2023

Preprint

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“…Finally, little is known about one-lung ventilation in obese patients undergoing thoracic surgery, but high levels of PEEP associated with RM seem to prevent atelectasis of the ventilated lung and to reopen closed alveoli, thus improving oxygenation and preventing postoperative hypoxemia [ 125 ]. Table 1 resumes the different strategies used to individualized PEEP described.…”

Section: Special Settings: Morbidity Obese Patientsmentioning

confidence: 99%

Management of Intraoperative Mechanical Ventilation to Prevent Postoperative Complications after General Anesthesia: A Narrative Review

Fogagnolo

Montanaro

Al-Husinat

et al. 2021

JCM

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Mechanical ventilation (MV) is still necessary in many surgical procedures; nonetheless, intraoperative MV is not free from harmful effects. Protective ventilation strategies, which include the combination of low tidal volume and adequate positive end expiratory pressure (PEEP) levels, are usually adopted to minimize the ventilation-induced lung injury and to avoid post-operative pulmonary complications (PPCs). Even so, volutrauma and atelectrauma may co-exist at different levels of tidal volume and PEEP, and therefore, the physiological response to the MV settings should be monitored in each patient. A personalized perioperative approach is gaining relevance in the field of intraoperative MV; in particular, many efforts have been made to individualize PEEP, giving more emphasis on physiological and functional status to the whole body. In this review, we summarized the latest findings about the optimization of PEEP and intraoperative MV in different surgical settings. Starting from a physiological point of view, we described how to approach the individualized MV and monitor the effects of MV on lung function.

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“…A large multicenter observational study discovered that, compared to ventilation with large tidal volume, ventilation with low tidal volume ( 5ml/kg predicted body weight) in combination with PEEP 5cmH 2 O, didn't reduce the incidence of postoperative pulmonary complications (PPCs) within 30 days after surgery [5]. Moreover, many randomized controlled trials discovered that a lung protective ventilation strategy involving low tidal volume combined with PEEP and RM could signi cantly reduce driving pressure and dead space, alleviate intrapulmonary shunt, improve oxygenation and reduce the incidence of PPCs; whereas the ventilation mode that incorporated low tidal volume combined with PEEP but without RM had limited effects on oxygenation and incidence of PPCs [1,6,7,8,9]. However, RM could cause delayed pulmonary in ammatory response and lung injury [1].…”

Section: Introductionmentioning

confidence: 99%

“…In many previous studies, patients received two lung ventilation without PEEP after being placed in lateral decubitus position, and one lung ventilation wasn't initiated until pleura opening [6,7,9]. Immediately after initiation of one lung ventilation, RM were performed followed by individualized PEEP (iPEEP) titration.…”

Section: Introductionmentioning

confidence: 99%

Effects of starting one lung ventilation and applying individualized PEEP right after patients are placed in lateral decubitus position on intraoperative oxygenation for patients undergoing thoracoscopic pulmonary lobectomy: study protocol for a randomized controlled trial

Wang,

Zhou,

Wang

et al. 2024

Preprint

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Background: For patients receiving one lung ventilation in thoracic surgery, numerous studies have proved the superiority of lung protective ventilation of low tidal volume combined with recruitment maneuvers (RM) and individualized PEEP. However, RM may lead to overinflation which aggravates lung injury and intrapulmonary shunt. In most previous studies, RM or PEEP was not applied until atelectasis has already formed. Because atelectasis usually does not develop the moment patients are turned into lateral decubitus position, we hypothesize that applying sufficient PEEP without RM immediately after patients are turned into that position is as effective to prevent atelectasis and thus improve oxygenation as applying PEEP with RM. Methods: A total of 84 patients scheduled for elective pulmonary lobe resection necessitating one lung ventilation will be recruited and randomized to the study group and the control group. For patients in the study group , one lung ventilation will be initiated right after the position of double lumen tube in lateral decubitus position is adjusted, and then individualized PEEP titration is applied. For patients in the control group, one lung ventilation will not be initiated until pleura is opened; and after the initiation, RM will be performed followed by individualized PEEP titration. The primary endpoint will be oxygenation index. Secondary endpoints will include intrapulmonary shunt, respiratory mechanics, PPCs, and hemodynamic indicators. Discussion: Numerous previous studies compared the effects of individualized PEEP applied alone with that applied in combination with RM on oxygenation index, PPCs, intrapulmonary shunt and respiratory mechanics after atelectasis was formed in patients receiving one lung ventilation during thoracoscopic surgery. In this study, we will apply individualized PEEP before the formation of atelectasis while not performing RM in patients allocated to the study group, and then we’re going to observe its effects on the aspects mentioned above. The results of this trial will provide a ventilation strategy that not only improves intraoperative oxygenation but also avoids the detrimental effects of RM for patients receiving one lung ventilation. Trial registration: www.Chictr.org.cn ChiCTR2400080682. Registered on February 5, 2024.

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Application of alveolar recruitment strategy and positive end-expiratory pressure combined with autoflow in the one-lung ventilation during thoracic surgery in obese patients

Cited by 7 publications

References 29 publications

Effectiveness of aerosol therapy on prevention and treatment of postoperative pulmonary complications of gastric cancer: a cross-sectional study based on a patients’ registry

Effectiveness of aerosol therapy on prevention and treatment of postoperative pulmonary complications of gastric cancer: a cross-sectional study based on a patients’ registry

Management of Intraoperative Mechanical Ventilation to Prevent Postoperative Complications after General Anesthesia: A Narrative Review

Effects of starting one lung ventilation and applying individualized PEEP right after patients are placed in lateral decubitus position on intraoperative oxygenation for patients undergoing thoracoscopic pulmonary lobectomy: study protocol for a randomized controlled trial

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