Impact of a Lung-Protective Ventilatory Strategy on Systemic and Pulmonary Inflammatory Responses During Laparoscopic Surgery: Is It Really Helpful?

Kokulu, Serdar; Günay, Ersin; Bakı, Elif Doğan; Ulaşlı, Sevinç Sarınç; Yılmazer, Mehmet; Koca, Buğra; Ariöz, Dağıstan Tolga; Ela, Yüksel; Sivaci, Remziye

doi:10.1007/s10753-014-0039-3

Cited by 13 publications

(8 citation statements)

References 23 publications

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“…The inflammatory factors increased slightly, and there was no significant difference between the two groups. The results of the present study are similar to those of previous studies with regard to inflammatory mediators (42,43) and PLOS (44).…”

Section: Discussionsupporting

confidence: 92%

Individualized lung protective ventilation vs. conventional ventilation during general anesthesia in laparoscopic total hysterectomy

Liu

Huang

et al. 2020

Exp Ther Med

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Laparoscopic total hysterectomy is performed by carbon dioxide insufflation, Trendelenburg position and mechanical ventilation of patients under general anesthesia. However, this may induce pulmonary atelectasis and/or hyperdistention of the lungs. Multiple studies have indicated that mechanical ventilation with the use of low tidal volumes, moderate positive end-expiratory pressure (PEEP) and regular alveolar recruitment maneuvers may improve post-operative outcomes. However, the benefits of an individualized level of PEEP have not been clearly established. In the present study, it was hypothesized that a moderate fixed PEEP may not suit all patients and an individually-titrated PEEP during anesthesia may improve the peri-operative pulmonary oxygenation function. The aim of the present study was to compare the pulmonary oxygenation function and post-operative pulmonary complications (PPCs) in patients receiving individualized lung-protective mechanical ventilation (LPV) vs. conventional ventilation (CV) during laparoscopic total hysterectomy. The present study was a randomized double-blinded clinical trial on 87 patients who were randomly divided to receive CV or protective ventilation (PV). An optimal individualized PEEP value was determined using a static pulmonary compliance-directed PEEP titration procedure. Pulmonary oxygenation function, serum inflammatory factors, including interleukin-8 and Clara cell protein 16, the incidence of PPCs and the post-operative length of stay were also determined. Patients in the PV group exhibited improved pulmonary oxygenation function during and after the operation. The total percentage of PPCs during the first 7 days after surgery was significantly lower in the PV group compared with those in the CV group. In conclusion, as compared to CV, intra-operative individualized LPV significantly improved pulmonary oxygenation function and reduced the incidence of PPCs during the first 7 days after laparoscopic total hysterectomy (Clinical trial registration no. ChiCTR1900027738).

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Section: Discussionsupporting

confidence: 92%

Individualized lung protective ventilation vs. conventional ventilation during general anesthesia in laparoscopic total hysterectomy

Liu

Huang

et al. 2020

Exp Ther Med

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“…A recent study demonstrated that there was no obvious evidence supporting atelectasis as the main cause of early postoperative fever [28]. Instead, surgical stress and the accompanying increase in circulating inflammatory cytokines may be associated with early postoperative fever [28,31]. The different ventilator modes may have affected surgical stress and the inflammatory response, but this issue was beyond the scope of the current study.…”

Section: Discussionmentioning

confidence: 76%

Volume-Controlled Versus Dual-Controlled Ventilation during Robot-Assisted Laparoscopic Prostatectomy with Steep Trendelenburg Position: A Randomized-Controlled Trial

Park

Choi

et al. 2019

JCM

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Dual-controlled ventilation (DCV) combines the advantages of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV). Carbon dioxide (CO2) pneumoperitoneum and steep Trendelenburg positioning for robot-assisted laparoscopic radical prostatectomy (RALRP) has negative effects on the respiratory system. We hypothesized that the use of autoflow as one type of DCV can reduce these effects during RALRP. Eighty patients undergoing RALRP were randomly assigned to receive VCV or DCV. Arterial oxygen tension (PaO2) as the primary outcome, respiratory and hemodynamic data, and postoperative fever rates were compared at four time points: 10 min after anesthesia induction (T1), 30 and 60 min after the initiation of CO2 pneumoperitoneum and Trendelenburg positioning (T2 and T3), and 10 min after supine positioning (T4). There were no significant differences in PaO2 between the two groups. Mean peak airway pressure (Ppeak) was significantly lower in group DCV than in group VCV at T2 (mean difference, 5.0 cm H2O; adjusted p < 0.001) and T3 (mean difference, 3.9 cm H2O; adjusted p < 0.001). Postoperative fever occurring within the first 2 days after surgery was more common in group VCV (12%) than in group DCV (3%) (p = 0.022). Compared with VCV, DCV did not improve oxygenation during RALRP. However, DCV significantly decreased Ppeak without hemodynamic instability.

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“…The role of lung‐protective ventilation in laparoscopic surgery is less clear. Initial studies have not shown a difference in inflammatory markers dependent on ventilation technique . The effect of different levels of PEEP on PPCs in obese patients is currently being explored in the PROBESE study (NCT02148692), in lung surgery in PROTHOR (NCT02963025) and in robotic surgery with high levels of head down tilt in AVATaR (NCT02989415).…”

Section: Are Lung‐protective Techniques Relevant To Patients Without mentioning

confidence: 99%

Respiratory complications of anaesthesia

Mills

2018

Anaesthesia

141

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Postoperative pulmonary complications are a major determinant of outcome for patients and consume huge resources within hospital, particularly in critical care. Prediction and anticipation of postoperative pulmonary complications are vital for patient selection and, in some cases, for informed patient consent. Being able to assess the likelihood of postoperative pulmonary complications also allows research into methods to reduce them by allowing allocation of patients to the appropriate arms of research trials. Some patients have pre-operative characteristics or belong to patient groups such as those with chronic obstructive pulmonary disease or obstructive sleep apnoea, where techniques and evidence-based guidance to avoid or reduce complications are becoming established. Intra-operative ventilation and the use of lung-protective ventilation may be helpful during major surgery, but studies looking at reduced tidal volumes, recruitment and levels of positive end-expiratory pressure, have this far only led to a degree of consensus in terms of tidal volume, although parameters that predispose to postoperative pulmonary complications are becoming clearer. Optimal postoperative care in terms of analgesia, positioning, physiotherapy and mobilisation is another developing area. Techniques such as continuous positive airways pressure, non-invasive ventilation and high-flow nasal humidified oxygen appear to show some benefit, but the exact roles, pressures and timings of each are currently being explored. Much remains to be researched and developed into evidence-based practice.

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Impact of a Lung-Protective Ventilatory Strategy on Systemic and Pulmonary Inflammatory Responses During Laparoscopic Surgery: Is It Really Helpful?

Cited by 13 publications

References 23 publications

Individualized lung protective ventilation vs. conventional ventilation during general anesthesia in laparoscopic total hysterectomy

Individualized lung protective ventilation vs. conventional ventilation during general anesthesia in laparoscopic total hysterectomy

Volume-Controlled Versus Dual-Controlled Ventilation during Robot-Assisted Laparoscopic Prostatectomy with Steep Trendelenburg Position: A Randomized-Controlled Trial

Respiratory complications of anaesthesia

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