Effects of intraoperative protective lung ventilation on postoperative pulmonary complications in patients with laparoscopic surgery: prospective, randomized and controlled trial

Abstract Background The intraoperative alveolar recruitment maneuver (ARM) efficiently treats atelectasis, but the effect of Fio 2 during ARM on atelectasis is uncertain. Here, we investigated this effect. Methods Patients undergoing elective laparoscopic surgery in the Trendelenburg position were randomized to low- (Fio 2 0.4; n=44) and high-Fio 2 (Fio 2 1.0, n=46) groups. ARMs were performed 1-min post tracheal intubation and post changes between supine and Trendelenburg positions during surgery. Intraoperative Fio 2 was set at 0.4 for both groups. Modified lung ultrasound (LUS) scores were calculated to assess lung aeration after inducing anesthesia and at surgery completion. The primary outcome was modified LUS score at the end of the surgery, and secondary outcomes were the intra- and postoperative Pao 2 to Fio 2 ratio and postoperative pulmonary complications. Results Both groups presented similar modified LUS scores before capnoperitoneum and ARM ( P =0.747). However, the postoperative modified LUS score was significantly lower in the low- than in the high-Fio 2 group (7.0±4.1 vs 11.7±4.2, mean difference 4.7, 95% CI 2.96–6.44, P <0.001). Significant atelectasis postoperatively was more common in the high-Fio 2 group (relative risk 1.77, 95% CI 1.27‒2.47, P <0.001). Intra- and postoperative Pao 2 to Fio 2 were similar and no postoperative pulmonary complications occurred. Atelectasis occurred more frequently when ARM was performed with high than with low Fio 2 . High-Fio 2 did not benefit oxygenation. Conclusions In patients undergoing laparoscopic surgery in the Trendelenburg position, absorption atelectasis occurred more frequently when the ARM was performed with high rather than low Fio 2 . No oxygenation benefit was observed in the high-Fio 2 group.

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Response to: ‘Postoperative pulmonary complications, pulmonary and systemic inflammatory responses after lung resection surgery with prolonged one-lung ventilation. Randomised controlled trial comparing intravenous and inhalational anaesthesia’

British Journal of Anaesthesia ◽

10.1016/j.bja.2017.12.016 ◽

2018 ◽

Vol 120 (2) ◽

pp. 411-412 ◽

Cited By ~ 1

Author(s):

E. Murphy ◽

B. Shelley

Keyword(s):

Randomised Controlled Trial ◽

Inflammatory Responses ◽

Controlled Trial ◽

Lung Resection ◽

Lung Ventilation ◽

Pulmonary Complications ◽

Postoperative Pulmonary Complications ◽

One Lung Ventilation ◽

Inhalational Anaesthesia ◽

Randomised Controlled

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The effect of the fraction of inspired oxygen during alveolar recruitment on absorption atelectasis in laparoscopic surgery: A randomized, controlled trial

10.21203/rs.3.rs-26725/v1 ◽

2020 ◽

Author(s):

Bo Rim Kim ◽

Seohee Lee ◽

Hansu Bae ◽

Minkyoo Lee ◽

Jae-Hyon Bahk ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Controlled Trial ◽

Pulmonary Complications ◽

Alveolar Recruitment ◽

Postoperative Pulmonary Complications ◽

Trendelenburg Position ◽

Alveolar Recruitment Maneuver ◽

Fraction Of Inspired Oxygen ◽

Inspired Oxygen ◽

Group Trial

Abstract Background The intraoperative alveolar recruitment maneuver (ARM) efficiently treats atelectasis, but the effect of Fio2 during ARM on atelectasis is uncertain. Here, we investigated this effect. Methods Patients undergoing elective laparoscopic surgery in the Trendelenburg position were randomized to low- (Fio2 0.4; n = 44) and high-Fio2 (Fio2 1.0, n = 46) groups. ARMs were performed 1-min post tracheal intubation and post changes between supine and Trendelenburg positions during surgery. Intraoperative Fio2 was set at 0.4 for both groups. Modified lung ultrasound (LUS) scores were calculated to assess lung aeration after inducing anesthesia and at surgery completion. The primary outcome was modified LUS score at the end of the surgery, and secondary outcomes were the intra- and postoperative Pao2 to Fio2 ratio and postoperative pulmonary complications. Results Both groups presented similar modified LUS scores before capnoperitoneum and ARM (P = 0.747). However, the postoperative modified LUS score was significantly lower in the low- than in the high-Fio2 group (7.0 ± 4.1 vs 11.7 ± 4.2, mean difference 4.7, 95% CI 2.96–6.44, P < 0.001). Significant atelectasis postoperatively was more common in the high-Fio2 group (relative risk 1.77, 95% CI 1.27‒2.47, P < 0.001). Intra- and postoperative Pao2 to Fio2 were similar and no postoperative pulmonary complications occurred. Atelectasis occurred more frequently when ARM was performed with high than with low Fio2. High-Fio2 did not benefit oxygenation. Conclusions In patients undergoing laparoscopic surgery in the Trendelenburg position, absorption atelectasis occurred more frequently when the ARM was performed with high rather than low Fio2. No oxygenation benefit was observed in the high-Fio2 group. Trial registration: ClinicalTrials.gov, NCT03943433. Registered 7 May 2019, https://clinicaltrials.gov/ct2/show/NCT03943433

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Postoperative pulmonary complications, pulmonary and systemic inflammatory responses after lung resection surgery with prolonged one-lung ventilation. Randomized controlled trial comparing intravenous and inhalational anaesthesia

British Journal of Anaesthesia ◽

10.1093/bja/aex230 ◽

2017 ◽

Vol 119 (4) ◽

pp. 655-663 ◽

Cited By ~ 32

Author(s):

F. de la Gala ◽

P. Piñeiro ◽

A. Reyes ◽

E. Vara ◽

L. Olmedilla ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Inflammatory Responses ◽

Controlled Trial ◽

Lung Resection ◽

Lung Ventilation ◽

Pulmonary Complications ◽

Postoperative Pulmonary Complications ◽

One Lung Ventilation ◽

Randomized Controlled ◽

Inhalational Anaesthesia

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Lung ultrasound score to determine the effect of fraction inspired oxygen during alveolar recruitment on absorption atelectasis in laparoscopic surgery: A randomized controlled trial

10.21203/rs.3.rs-26725/v3 ◽

2020 ◽

Author(s):

Bo Rim Kim ◽

Seohee Lee ◽

Hansu Bae ◽

Minkyoo Lee ◽

Jae-Hyon Bahk ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Laparoscopic Surgery ◽

Lung Ultrasound ◽

Controlled Trial ◽

Pulmonary Complications ◽

Alveolar Recruitment ◽

Postoperative Pulmonary Complications ◽

Trendelenburg Position ◽

Randomized Controlled ◽

Ultrasound Score

Abstract Background: Although the intraoperative alveolar recruitment maneuver (RM) efficiently treats atelectasis, the effect of Fio2 on atelectasis during RM is uncertain. We hypothesized that a high Fio2 (1.0) during RM would lead to a higher degree of postoperative atelectasis without benefiting oxygenation when compared to low Fio2 (0.4). Methods: In this randomized controlled trial, patients undergoing elective laparoscopic surgery in the Trendelenburg position were allocated to low- (Fio2 0.4, n=44) and high-Fio2 (Fio2 1.0, n=46) groups. RM was performed 1-min post tracheal intubation and post changes in supine and Trendelenburg positions during surgery. We set the intraoperative Fio2 at 0.4 for both groups and calculated the modified lung ultrasound score (LUSS) to assess lung aeration after anesthesia induction and at surgery completion. The primary outcome was modified LUSS at the end of the surgery. The secondary outcomes were the intra- and postoperative Pao2 to Fio2 ratio and postoperative pulmonary complications. Results: The modified LUSS before capnoperitoneum and RM (P=0.747) were similar in both groups. However, the postoperative modified LUSS was significantly lower in the low Fio2 group (median difference 5.0, 95% CI 3.0‒7.0, P<0.001). Postoperatively, substantial atelectasis was more common in the high-Fio2 group (relative risk 1.77, 95% CI 1.27‒2.47, P<0.001). Intra- and postoperative Pao2 to Fio2 were similar with no postoperative pulmonary complications. Atelectasis occurred more frequently when RM was performed with high than with low Fio2; oxygenation was not benefitted by a high-Fio2.Conclusions: In patients undergoing laparoscopic surgery in the Trendelenburg position, absorption atelectasis occurred more frequently with high rather than low Fio2. No oxygenation benefit was observed in the high-Fio2 group. Trial registration: ClinicalTrials.gov, NCT03943433. Registered 7 May 2019, https://clinicaltrials.gov/ct2/show/NCT03943433

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Nurse‐guided incentive spirometry use and postoperative pulmonary complications among cardiac surgery patients: A randomized controlled trial

International Journal of Nursing Practice ◽

10.1111/ijn.13023 ◽

2021 ◽

Author(s):

Saja Ahmad Alwekhyan ◽

Jafar Alasad Alshraideh ◽

Khalil Moh'd Yousef ◽

Ferial Hayajneh

Keyword(s):

Randomized Controlled Trial ◽

Cardiac Surgery ◽

Controlled Trial ◽

Pulmonary Complications ◽

Postoperative Pulmonary Complications ◽

Randomized Controlled ◽

Incentive Spirometry

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Driving Pressure during Thoracic Surgery

Anesthesiology ◽

10.1097/aln.0000000000002600 ◽

2019 ◽

Vol 130 (3) ◽

pp. 385-393 ◽

Cited By ~ 31

Author(s):

MiHye Park ◽

Hyun Joo Ahn ◽

Jie Ae Kim ◽

Mikyung Yang ◽

Burn Young Heo ◽

...

Keyword(s):

Thoracic Surgery ◽

Tidal Volume ◽

Odds Ratio ◽

Lung Ventilation ◽

Pulmonary Complications ◽

Protective Ventilation ◽

Driving Pressure ◽

Pressure Group ◽

Postoperative Pulmonary Complications ◽

One Lung Ventilation

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Recently, several retrospective studies have suggested that pulmonary complication is related with driving pressure more than any other ventilatory parameter. Thus, the authors compared driving pressure–guided ventilation with conventional protective ventilation in thoracic surgery, where lung protection is of the utmost importance. The authors hypothesized that driving pressure–guided ventilation decreases postoperative pulmonary complications more than conventional protective ventilation. Methods In this double-blind, randomized, controlled study, 292 patients scheduled for elective thoracic surgery were included in the analysis. The protective ventilation group (n = 147) received conventional protective ventilation during one-lung ventilation: tidal volume 6 ml/kg of ideal body weight, positive end-expiratory pressure (PEEP) 5 cm H2O, and recruitment maneuver. The driving pressure group (n = 145) received the same tidal volume and recruitment, but with individualized PEEP which produces the lowest driving pressure (plateau pressure–PEEP) during one-lung ventilation. The primary outcome was postoperative pulmonary complications based on the Melbourne Group Scale (at least 4) until postoperative day 3. Results Melbourne Group Scale of at least 4 occurred in 8 of 145 patients (5.5%) in the driving pressure group, as compared with 18 of 147 (12.2%) in the protective ventilation group (P = 0.047, odds ratio 0.42; 95% CI, 0.18 to 0.99). The number of patients who developed pneumonia or acute respiratory distress syndrome was less in the driving pressure group than in the protective ventilation group (10/145 [6.9%] vs. 22/147 [15.0%], P = 0.028, odds ratio 0.42; 95% CI, 0.19 to 0.92). Conclusions Application of driving pressure–guided ventilation during one-lung ventilation was associated with a lower incidence of postoperative pulmonary complications compared with conventional protective ventilation in thoracic surgery.

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