Protective ventilation during anaesthesia reduces major postoperative complications after lung cancer surgery

Marret, Emmanuel; Cinotti, Raphaël; Bérard, Laurence; Piriou, Vincent; Jobard, Jacques; Barrucand, Benoit; Radu, Dragos; Jaber, Samir; Bonnet, Francis

doi:10.1097/eja.0000000000000804

Cited by 81 publications

(65 citation statements)

References 36 publications

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“…As described above, lung protective ventilation not only improved respiratory parameters but also suppressed NLRP3 in ammasome-related in ammatory cytokine secretion and restored the level of endogenous MT: which are likely to be required to improve outcomes during esophageal surgery. Indeed, lung protective ventilation not only reduced the incidence of pulmonary complications but also decreased the rate of major postoperative complications in our study, consistent with the results reported by Marret [29].…”

Section: Discussionsupporting

confidence: 93%

The Effects of Protective Ventilation on the Production of Endogenous Melatonin and Prognosis in Patients Undergoing Esophageal Cancer Surgery: A Prospective Randomized Double-Blind Controlled Study

Wang

Huang

et al. 2020

Preprint

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Background: Exogenous melatonin exerts a similar effect to protective ventilation on attenuating ventilator-induced lung injury (VILI) by inhibiting NLRP3 inflammasome activation in mouse model. However, the effect of protective ventilation on the production of endogenous melatonin and prognosis in patients undergoing esophageal cancer surgery remains unknown. In this study, we aimed to reveal the effects of protective ventilation on the production of endogenous melatonin, interleukin (IL)-1β, IL-18 and major complications in patients undergoing esophageal cancer surgery. Methods: Eight-eight patients were randomized to receive “conventional” ventilation (Vt=10 mL/kg) or lung protective ventilation [Vt=5 mL/kg along with 5 cm of H2O positive end-expiratory pressure (PEEP)]. IL-1β, IL-18 and melatonin levels in bronchoalveolar lavage fluid (BALF) and serum were measured. Respiratory variables and outcomes were evaluated.Results: Lung protective ventilation decreased the peak airway pressure (Ppeak), plateau airway pressure (Pplat) and driving pressure (ΔP) compared with the “conventional” ventilation group. Lung protective ventilation inhibited polymorphonuclear (PMN) cells invasion into the BALF (P=0.000). Likewise, lung protective ventilation suppressed alveolar and serum IL-1β and IL-18 secretion after mechanical ventilation. Furthermore, lung protective ventilation resulted in a decrease in the inhibition of endogenous MT production compared to “conventional” ventilation (P=0.000). In addition, lung protective ventilation reduced the incidence of postoperative pulmonary complications (P=0.04) and the rate of major postoperative complications (P=0.023).Conclusions: Taken together, lung protective ventilation for esophageal cancer surgery suppressed the secretion of IL-1β, IL-18 and restored the endogenous melatonin level. Meanwhile, lung protective ventilation improved postoperative outcomes after esophageal cancer surgery.Trial registration: The Chinese Clinical Trial Registry, ChiCTR1900026190. Registered 25 September 2019, http://www.chictr.org.cn/edit.aspx?pid=34677&htm=4

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Section: Discussionsupporting

confidence: 93%

The Effects of Protective Ventilation on the Production of Endogenous Melatonin and Prognosis in Patients Undergoing Esophageal Cancer Surgery: A Prospective Randomized Double-Blind Controlled Study

Wang

Huang

et al. 2020

Preprint

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“…Preventing PPCs with specific perioperative ventilatory management is not a new approach [ 16 ]. Many reports have described the concept of protective ventilation [ 17 , 18 ]. Inspired by the results obtained in critical care medicine in patients with acute respiratory distress syndrome (ARDS) [ 19 ], the use of low tidal volumes (6–8 mL/kg predicted body weight) has spread to the operating theater [ 20 – 22 ] and there is now an established consensus [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

A perioperative surgeon-controlled open-lung approach versus conventional protective ventilation with low positive end-expiratory pressure in cardiac surgery with cardiopulmonary bypass (PROVECS): study protocol for a randomized controlled trial

Lagier¹,

Fischer²,

Fornier³

et al. 2018

Trials

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BackgroundPostoperative pulmonary complications (PPCs) are frequent after on-pump cardiac surgery. Cardiac surgery results in a complex pulmonary insult leading to high susceptibility to perioperative pulmonary atelectasis. For technical reasons, ventilator settings interact with the surgical procedure and traditionally, low levels of positive end-expiratory pressure (PEEP) have been used. The objective is to compare a perioperative, multimodal and surgeon-controlled open-lung approach with conventional protective ventilation with low PEEP to prevent PPCs in patients undergoing cardiac surgery.Methods/designThe perioperative open-lung protective ventilation in cardiac surgery (PROVECS) trial is a multicenter, two-arm, randomized controlled trial. In total, 494 patients scheduled for elective cardiac surgery with cardiopulmonary bypass (CPB) and aortic cross-clamp will be randomized into one of the two treatment arms. In the experimental group, systematic recruitment maneuvers and perioperative high PEEP (8 cmH2O) are associated with ultra-protective ventilation during CPB. In this group, the settings of the ventilator are controlled by surgeons in relation to standardized protocol deviations. In the control group, no recruitment maneuvers, low levels of PEEP (2 cmH2O) and continuous positive airway pressure during CPB (2 cmH2O) are used. Low tidal volumes (6–8 mL/kg of predicted body weight) are used before and after CPB in each group. The primary endpoint is a composite of the single PPCs evaluated during the first 7 postoperative days.DiscussionThe PROVECS trial will be the first multicenter randomized controlled trial to evaluate the impact of a perioperative and multimodal open-lung ventilatory strategy on the occurrence of PPCs after on-pump cardiac surgery. The trial design includes standardized surgeon-controlled protocol deviations that guarantee a pragmatic approach. The results will help anesthesiologists and surgeons aiming to optimize ventilatory settings during cardiac surgery.Trial registrationClinical Trials.gov, NCT 02866578. Registered on 15 August 2016. Last updated 11 July 2017.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2967-y) contains supplementary material, which is available to authorized users.

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“…Arterial blood gas (ABG) was recorded at T1, T3, T5 (30 min after tracheal extubation) and T6 (the day after the surgery). The lung oxygenation ability was assessed by determining the oxygen index (OI) calculated from the pressure of arterial oxygen (PaO 2 ) and FiO 2 as OI=PaO 2 /FiO 2 (29). Alveolar-arterial differences for oxygen (A-aO 2 ) were calculated from the atmospheric pressure (PB), saturated vapor pressure at room temperature (PH 2 O), pressure of arterial carbon dioxide (PaCO 2 ) and respiration quotient (R), PaO 2 and FiO 2 as A-aO 2 =(PB-PH 2 O) x FiO 2 -PaCO 2 /R-PaO 2 (30), with PB set at 760 mmHg, PH 2 O at 47 mmHg and R at 0.8.…”

Section: Methodsmentioning

confidence: 99%

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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Protective ventilation during anaesthesia reduces major postoperative complications after lung cancer surgery

Abstract: ClinicalTrials.gov number: NCT00805077.

Cited by 81 publications

References 36 publications

The Effects of Protective Ventilation on the Production of Endogenous Melatonin and Prognosis in Patients Undergoing Esophageal Cancer Surgery: A Prospective Randomized Double-Blind Controlled Study

The Effects of Protective Ventilation on the Production of Endogenous Melatonin and Prognosis in Patients Undergoing Esophageal Cancer Surgery: A Prospective Randomized Double-Blind Controlled Study

A perioperative surgeon-controlled open-lung approach versus conventional protective ventilation with low positive end-expiratory pressure in cardiac surgery with cardiopulmonary bypass (PROVECS): study protocol for a randomized controlled trial

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

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