Effect of Intensive vs Moderate Alveolar Recruitment Strategies Added to Lung-Protective Ventilation on Postoperative Pulmonary Complications

Leme, A; Hajjar, Ludhmila Abrahão; Volpe, Márcia Souza; Fukushima, Júlia Tizue; Santiago, Roberta Ribeiro De Santis; Osawa, E; Almeida, Juliano Pinheiro de; Gerent, A; Franco, Rafael Alves; Feltrim, Maria Ignêz Z.; Nozawa, Emı́lia; Coimbra, Vera Regina de Moraes; Ianotti, Rafael de Moraes; Hashizume, Clarice Shiguemi; Filho, Roberto Kalil; Auler, José Otávio Costa; Jatene, Fábio Biscegli; Galas, Filomena Regina Barbosa Gomes; Amato, Marcelo Britto Passos

doi:10.1001/jama.2017.2297

Cited by 107 publications

(93 citation statements)

References 29 publications

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“…For patients at high risk for extubation failure, NIV is recommended after extubation as this may significantly reduce the ICU length of stay and mortality [ 73 ]. In some specific scenarios, for patients with high risk of lung collapse (e.g., morbid obesity or in patients after cardiac surgery), direct extubation from CPAP levels ≥ 10 cmH 2 O (or PEEP ≥ 10 cmH 2 O plus low levels of pressure support) has been used with success, resulting in reduced postoperative pulmonary complications [ 74 ].…”

Section: Statementsmentioning

confidence: 99%

Respiratory support in patients with acute respiratory distress syndrome: an expert opinion

et al. 2017

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Acute respiratory distress syndrome (ARDS) is a common condition in intensive care unit patients and remains a major concern, with mortality rates of around 30–45% and considerable long-term morbidity. Respiratory support in these patients must be optimized to ensure adequate gas exchange while minimizing the risks of ventilator-induced lung injury. The aim of this expert opinion document is to review the available clinical evidence related to ventilator support and adjuvant therapies in order to provide evidence-based and experience-based clinical recommendations for the management of patients with ARDS.

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Section: Statementsmentioning

confidence: 99%

Respiratory support in patients with acute respiratory distress syndrome: an expert opinion

et al. 2017

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“…Unlike studies addressing measures of complete or partial LPV in heart surgery under CPB in adults, 16,17 related studies in children only reported with lung recruitment using peak airway pressure of 40 cm H 2 O with 8 cm H 2 O PEEP 18 and the safety of lung recruitment by using 10 and 15 cm H 2 O PEEP in pediatric patients with severe CHD 19 . In the present study, we tried to use a complete LPVS in infants undergoing CPB surgery for CHD, including LTVV, appropriate PEEP, and PEEP increment during lung recruitment.…”

Section: Discussionmentioning

confidence: 97%

Lung protective ventilation in infants undergoing cardiopulmonary bypass surgery for congenital heart disease: A prospective randomized controlled trial

Sun

Shen

Deng

et al. 2020

Pediatric Anesthesia

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Background Lung protective ventilation (LPV) has been applied to surgical adults with normal pulmonary function for optimizing mechanical ventilation and reducing postoperative pulmonary complications. Few studies have reported the use of LPV in infants undergoing cardiac surgery with cardiopulmonary bypass (CPB). Aims To explore safety and effectiveness of LPV in infants undergoing CPB surgery for congenital heart disease (CHD). Methods Included in this study were 77 infants who underwent CPB surgery for CHD from November 2017 to September 2018. They were randomized into the LPV group and conventional ventilation (CV) group. In the LPV group, small‐tidal‐volume (6‐8 ml/kg) ventilation, lung recruitment by PEEP increment to the maximum level of 15 cm H2O after CPB, and individualized optimal PEEP titration were applied. In the CV group, traditional tidal volume (10‐12 ml/kg with zero PEEP) was applied. The primary outcome was the ratio of arterial partial pressure of oxygen to inspiratory oxygen fraction (PaO2/FiO2). The secondary outcomes were respiratory dynamic parameters, hypoxemia, prognostic indexes, and postoperative pulmonary complications. Results PaO2/FiO2 in the LPV group (416.86, 95%CI: 381.60‐452.12) was significantly higher than that in the CV group (263.37, 95%CI: 227.65‐299.09) after intervention (P < .001). There was a significant difference in the trend of change in dynamic compliance, alveolar‐arterial oxygen difference, arterial‐end‐expired carbon dioxide difference, driving pressure, and respiratory index between the two groups at different time points from weaning from CPB to 2 hours after operation. There was no significant difference in PaO2/FiO2, alveolar‐arterial oxygen difference, respiratory index, and dynamic compliance 2 hours postoperative and in the incidence of postoperative pulmonary complications, prognostic indexes between the two groups. Conclusions LPV could be used safely in infants undergoing CPB in that it can improve oxygenation, alveolar aeration, and dynamic compliance, and reduce driving pressure, pulmonary shunting, and dead space. Its effect on oxygenation, pulmonary gas exchange, and pulmonary compliance was relatively short, and had less impact on postoperative pulmonary complications and prognosis.

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“…However, traditional protective lung ventilation strategies often need to gradually increase PEEP to the level of 20 cm H2O or even higher [6,10], which will obviously affect the circulation and intracranial pressure of patients [13], and may increase airway pressure, reduce cerebral venous reflux and intraoperative operating space, thus limiting its application in patients with craniotomy. In addition, in clinical work, anesthesiologists often use a single PEEP or pulmonary retention mode, ignoring individual differences among patients, thus affecting the effect of protective lung ventilation [1,14,15].…”

Section: Introductionmentioning

confidence: 99%

The effects of protective lung ventilation on regional cerebral oxygen saturation in intracranial tumor operative during dura opening：study protocol for a randomized controlled trial

Liu³

et al. 2019

Preprint

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Objective:To investigate the effects of protective lung ventilation on regional cerebral oxygen saturation during dura opening, that is from after dura opening (T1a) to before dura closing (T2b), in patients undergoing intracranial tumor surgery. Methods: This is a randomized, controlled trial which will be carried out at the second affiliated hospital of Soochow University. Fifty-four patients undergoing intracranial tumor surgery will be randomly allocated to the control group and the protective lung ventilation group. In the control group, tidal volume (VT) will be set at 8 ml/kg of ideal body weight, but positive end-expiratory pressure (PEEP) and recruitment maneuvers will not be used. In the protective lung ventilation group, VT will be set at 6 ml/kg of ideal body weight combined with individualized PEEP (PEEPx) during intraoperative dura mater opening, but in other periods of general anesthesia, VT will be set at 8 ml/kg of ideal body weight. Titration method of individualized PEEP (PEEPx) [1]: VT and respiratory rate will be fixed at 6ml/kg and 15 beats per minute during PEEP trial. Titration can only begin once the dura is opened. The titration for the individual PEEP can then be initiated by increasing PEEP from 2 to 10cm H2O incrementally. Each PEEP level (2, 3, 4, 5, 6, 7, 8, 9, 10cm H2O) will be maintained for 1 minute, and the pulmonary compliance of the last cycle will be recorded at each PEEP level. At last, the PEEP value at the highest compliance will be selected as the individual PEEP of patient. Regional cerebral oxygen saturation (rSO2), partial pressure of oxygen and carbon dioxide, oxygenation index, lactic acid level in arterial blood, and mean arterial pressure will be compared before anesthesia (T0), before dura opening (T1), after dura closing (T2) and 24 h after surgery (T3). Pulmonary ultrasound scores will be performed at T0 and T3.The degree of brain relaxation before and after protective lung ventilation will be evaluated by the surgeon using the brain relaxation scale. Amount of vasoactive drugs used and blood loss will be recorded during intraoperative dura mater opening. The total duration and secondary rate of surgery also will be recorded. Discussion: This study aims to determine whether intraoperative pulmonary protection strategy can improve regional cerebral oxygen saturation in patients undergoing intracranial tumor surgery, and to investigate whether intraoperative pulmonary protection strategy does not affect the degree of brain tissue swelling and the amount of blood loss during surgery. If our results are positive, this study will show that intraoperative pulmonary protection strategy can be used effectively and safely in neurosurgical patients undergoing craniotomy for tumor resection. Trial registration: chictr.org.cn, ID: ChiCTR1900025632. Registered on 3 September 2019. tudy protocol version 1.0.

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Effect of Intensive vs Moderate Alveolar Recruitment Strategies Added to Lung-Protective Ventilation on Postoperative Pulmonary Complications

Abstract: clinicaltrials.gov Identifier: NCT01502332.

Cited by 107 publications

References 29 publications

Respiratory support in patients with acute respiratory distress syndrome: an expert opinion

Respiratory support in patients with acute respiratory distress syndrome: an expert opinion

Lung protective ventilation in infants undergoing cardiopulmonary bypass surgery for congenital heart disease: A prospective randomized controlled trial

The effects of protective lung ventilation on regional cerebral oxygen saturation in intracranial tumor operative during dura opening：study protocol for a randomized controlled trial

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