Effect of driving pressure-guided positive end-expiratory pressure (PEEP) titration on postoperative lung atelectasis in adult patients undergoing elective major abdominal surgery: A randomized controlled trial

Mini, Gouri; Ray, Bikash Ranjan; Anand, Rahul; Muthiah, Thilaka; Baidya, Dalim Kumar; Rewari, Vimi; Sahni, Peush; Maitra, Souvik

doi:10.1016/j.surg.2021.01.047

Cited by 16 publications

(11 citation statements)

References 22 publications

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“…In its mediation analysis, ΔP is the only important mediator of protective ventilation on pulmonary complications [ 9 ]. In addition, Park et al [ 10 ] found that the application of ΔP in single-lung ventilation reduced postoperative pulmonary complications compared to conventional protected ventilation in thoracic surgery, and Gouri Mini et al [ 11 ] found that individualized PEEP with ΔP titration reduced postoperative pulmonary atelectasis in open surgery. Therefore titrating PEEP to obtain the lowest ΔP may be an effective strategy to reduce the occurrence of atelectasis.…”

Section: Introductionmentioning

confidence: 99%

Effects of dynamic individualized PEEP guided by driving pressure in laparoscopic surgery on postoperative atelectasis in elderly patients: a prospective randomized controlled trial

Liu

et al. 2022

BMC Anesthesiol

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Background Driving pressure (ΔP = Plateau pressure-PEEP) is highly correlated with postoperative pulmonary complications (PPCs) and appears to be a promising indicator for optimizing ventilator settings. We hypothesized that dynamic, individualized positive end-expiratory pressure (PEEP) guided by ΔP could reduce postoperative atelectasis and improve intraoperative oxygenation, respiratory mechanics, and reduce the incidence of PPCs on elderly patients undergoing laparoscopic surgery. Methods Fifty-one elderly patients who were subject to laparoscopic surgery participated in this randomized trial. In the PEEP titration group (DV group), the PEEP titration was decremented to the lowest ΔP and repeated every 1 h. Additional procedures were also performed when performing predefined events that may be associated with lung collapse. In the constant PEEP group (PV group), a PEEP of 6 cmH2O was used throughout the surgery. Moreover, zero PEEP was applied during the entire procedure in the conventional ventilation group (CV group). The primary objective of this study was lung ultrasound score noted at the end of surgery and 15 min after admission to the post-anesthesia care unit (PACU) at 12 lung areas bilaterally. The secondary endpoints were perioperative oxygenation function, expiratory mechanics, and the incidence of the PPCs. Results The lung ultrasound scores of the DV group were significantly lower than those in the PV group and CV group (P < 0.05), whereas there was no significant difference between the PV group and CV group (P > 0.05). The lung static compliance (Cstat) and ΔP at all the intraoperative time points in the DV group were significantly better compared to the PV group and the CV group (p < 0.05). Conclusions Intraoperative titrated PEEP reduced postoperative lung atelectasis and improved respiratory mechanics in elderly patients undergoing laparoscopic surgery. Meanwhile, standard PEEP strategy is not superior to conventional ventilation in reducing postoperative pulmonary atelectasis in laparoscopic surgery.

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Section: Introductionmentioning

confidence: 99%

Effects of dynamic individualized PEEP guided by driving pressure in laparoscopic surgery on postoperative atelectasis in elderly patients: a prospective randomized controlled trial

Liu

et al. 2022

BMC Anesthesiol

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“…P peak , P mean and Cdyn are three commonly used respiratory mechanical indicators that can reflect lung compliance, airway resistance and alveolar pressure[ 18 , 19 ]. The results of this study showed that there were no significant differences in P peak , P mean and Cdyn at T0 between the patients in group A and group B ( P > 0.05).…”

Section: Discussionmentioning

confidence: 99%

Different positive end expiratory pressure and tidal volume controls on lung protection and inflammatory factors during surgical anesthesia

Wang¹,

Yang²,

Wang³

et al. 2022

World J Clin Cases

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BACKGROUND Mechanical ventilation can lead to the severe impairment of the metabolic pathway of alveolar surfactants, inactivating alveolar surfactants and significantly reducing lung-chest compliance. The cardiopulmonary function of elderly patients usually reduced to a certain extent, and there are lung complications after surgical anesthesia, just like lung barotrauma caused by mechanical ventilation, atelectasis and postoperative hypoxemia. AIM To investigate the effects of different positive end expiratory pressures (PEEPs) and tidal volumes (VTs) on respiratory function, the degree of the inflammatory response and hemodynamic indexes in patients undergoing surgery under general anesthesia. METHODS A total of 120 patients undergoing surgery for gastric or colon cancer under general anesthesia in Xinghua People's Hospital from January 2017 to January 2021 were randomly divided into Group A and Group B, with 60 cases in each group. The ventilation mode in Group A was VT (6.0 mL/kg) + PEEP (5.0 cmH 2 O), while that in Group B was VT (6.0 mL/kg) + PEEP (8.0 cmH 2 O). Blood gas parameters, respiratory mechanical parameters, inflammatory response indicators, hemodynamic indicators and related complications were compared between the two groups. RESULTS There were no significant differences in PaCO 2 , PaO 2 , oxygen or the examined indexes at T0 between group A and group B ( P > 0.05). The measured PaO 2 value of patients in group A at T3 was higher than that in group B, and the difference was significant ( P < 0.05). There were no significant differences in peak airway pressure (P peak ), mean airway pressure or dynamic pulmonary compliance (Cdyn) at T0 between group A and group B ( P > 0.05). The measured P peak value of patients in group A at T1 was higher than that in group B, and the difference was significant ( P < 0.05). The measured Cdyn value at T1 and T2 was greater than that in group B ( P < 0.05). Before surgery, there were no significant differences in tumor necrosis factor-α (TNF-α), interleukin (IL)-6 or IL-10 between group A and group B ( P > 0.05). After 4 h, the measured values of TNF-α and IL-6 in group A were lower than those in group B, and the differences were significant ( P < 0.05). The IL-10 Level in group A was higher than that in group B ( P < 0.05). At T0, there were no significant differences in cardiac output, cardiac index (CI), stroke volume index (SVI) or mean arterial pressure between group A and group B ( P > 0.05). The measured values of CI and SVI at T...

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“…[40][41][42] Similarly, there are multiple studies showing improved oxygenation and reduction in postoperative hypoxemic events when PEEP is utilized. 43,44 While PEEP itself is recommended, the panel cannot recommend a specific PEEP value or range of values.…”

Section: Discussionmentioning

confidence: 99%

“…Considering specific ventilatory strategies, there is significant literature supporting low‐tidal volume ventilation in abdominal surgery in overall improved mortality and reduction in pulmonary complications 40–42 . Similarly, there are multiple studies showing improved oxygenation and reduction in postoperative hypoxemic events when PEEP is utilized 43,44 . While PEEP itself is recommended, the panel cannot recommend a specific PEEP value or range of values.…”

Section: Discussionmentioning

confidence: 99%

Optimal anesthetic conduct regarding immediate and short‐term outcomes after liver transplantation – Systematic review of the literature and expert panel recommendations

Chadha

Patel

Bhangui

et al. 2022

Clinical Transplantation

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Effect of driving pressure-guided positive end-expiratory pressure (PEEP) titration on postoperative lung atelectasis in adult patients undergoing elective major abdominal surgery: A randomized controlled trial

Cited by 16 publications

References 22 publications

Effects of dynamic individualized PEEP guided by driving pressure in laparoscopic surgery on postoperative atelectasis in elderly patients: a prospective randomized controlled trial

Effects of dynamic individualized PEEP guided by driving pressure in laparoscopic surgery on postoperative atelectasis in elderly patients: a prospective randomized controlled trial

Different positive end expiratory pressure and tidal volume controls on lung protection and inflammatory factors during surgical anesthesia

Optimal anesthetic conduct regarding immediate and short‐term outcomes after liver transplantation – Systematic review of the literature and expert panel recommendations

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