Effect of a protective-ventilation strategy on systemic inflammation after esophagectomy

Background Esophagectomy induces a systemic inflammatory response whose extent has been recognized as a predictive factor of postoperative respiratory morbidity. The aim of this study was to determine the effectiveness of a protective ventilatory strategy to reduce systemic inflammation in patients undergoing esophagectomy. Methods The authors prospectively investigated 52 patients undergoing planned esophagectomy for cancer. Patients were randomly assigned to a conventional ventilation strategy (n = 26; tidal volume of 9 ml/kg during two-lung and one-lung ventilation; no positive end-expiratory pressure) or a protective ventilation strategy (n = 26; tidal volume of 9 ml/kg during two-lung ventilation, reduced to 5 ml/kg during one-lung ventilation; positive end-expiratory pressure 5 cm H2O throughout the operative time). Results Plasmatic levels of interleukin (IL)-1beta, IL-6, IL-8, and tumor necrosis factor alpha were measured perioperatively and postoperatively. Pulmonary function and postoperative evolution were also evaluated. Patients who received protective strategy had lower blood levels of IL-1beta, IL-6, and IL-8 at the end of one-lung ventilation (0.24 [0.15-0.40] vs. 0.56 [0.38-0.89] pg/ml, P < 0.001; 91 [61-117] vs. 189 [127-294] pg/ml, P < 0.001; and 30 [22-45] vs. 49 [29-69] pg/ml, P < 0.05, respectively) and 18 h postoperatively (0.18 [0.13-0.30] vs. 0.43 [0.34-0.54] pg/ml, P < 0.001; 54 [36-89] vs. 116 [78-208] pg/ml, P < 0.001; 16 [11-24] vs. 35 [28-53] pg/ml, P < 0.001, respectively). Protective strategy resulted in higher oxygen partial pressure to inspired oxygen fraction ratio during one-lung ventilation and 1 h postoperatively and in a reduction of postoperative mechanical ventilation duration (115 +/- 38 vs. 171 +/- 57 min, P < 0.001). Conclusion A protective ventilatory strategy decreases the proinflammatory systemic response after esophagectomy, improves lung function, and results in earlier extubation.

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Effects of lung-protective ventilation strategy on lung aeration loss and postoperative pulmonary complications in moderate-risk patients undergoing abdominal surgery

Minerva Anestesiologica ◽

10.23736/s0375-9393.20.14951-4 ◽

2021 ◽

Vol 87 (6) ◽

Author(s):

Yu FU ◽

Yan-Wei ZHANG ◽

Jie GAO ◽

Hui-Min FU ◽

Ling SI ◽

...

Keyword(s):

Pulmonary Complications ◽

Protective Ventilation ◽

Lung Protective Ventilation ◽

Ventilation Strategy ◽

Postoperative Pulmonary Complications ◽

Moderate Risk ◽

Lung Aeration ◽

Protective Ventilation Strategy ◽

Risk Patients ◽

Lung Protective Ventilation Strategy

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Lung protective ventilation strategy for the acute respiratory distress syndrome

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd003844.pub4 ◽

2013 ◽

Cited By ~ 72

Author(s):

Nicola Petrucci ◽

Carlo De Feo

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Protective Ventilation ◽

Lung Protective Ventilation ◽

Ventilation Strategy ◽

Protective Ventilation Strategy ◽

Lung Protective Ventilation Strategy

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Does a Protective Ventilation Strategy Reduce the Risk of Pulmonary Complications After Lung Cancer Surgery?

CHEST Journal ◽

10.1378/chest.09-2293 ◽

2011 ◽

Vol 139 (3) ◽

pp. 530-537 ◽

Cited By ~ 103

Author(s):

Mikyung Yang ◽

Hyun Joo Ahn ◽

Kwhanmien Kim ◽

Jie Ae Kim ◽

Chin A Yi ◽

...

Keyword(s):

Lung Cancer ◽

Lung Cancer Surgery ◽

Pulmonary Complications ◽

Protective Ventilation ◽

Cancer Surgery ◽

Ventilation Strategy ◽

Protective Ventilation Strategy

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Protective Mechanical Ventilation during General Anesthesia for Open Abdominal Surgery Improves Postoperative Pulmonary Function

Anesthesiology ◽

10.1097/aln.0b013e31829102de ◽

2013 ◽

Vol 118 (6) ◽

pp. 1307-1321 ◽

Cited By ~ 248

Author(s):

Paolo Severgnini ◽

Gabriele Selmo ◽

Christian Lanza ◽

Alessandro Chiesa ◽

Alice Frigerio ◽

...

Keyword(s):

Mechanical Ventilation ◽

Abdominal Surgery ◽

Pulmonary Infection ◽

Ideal Body Weight ◽

Protective Ventilation ◽

Clinical Pulmonary Infection Score ◽

Ventilation Strategy ◽

Protective Ventilation Strategy ◽

Open Abdominal Surgery ◽

Protective Mechanical Ventilation

Abstract Background: The impact of intraoperative ventilation on postoperative pulmonary complications is not defined. The authors aimed at determining the effectiveness of protective mechanical ventilation during open abdominal surgery on a modified Clinical Pulmonary Infection Score as primary outcome and postoperative pulmonary function. Methods: Prospective randomized, open-label, clinical trial performed in 56 patients scheduled to undergo elective open abdominal surgery lasting more than 2 h. Patients were assigned by envelopes to mechanical ventilation with tidal volume of 9 ml/kg ideal body weight and zero-positive end-expiratory pressure (standard ventilation strategy) or tidal volumes of 7 ml/kg ideal body weight, 10 cm H2O positive end-expiratory pressure, and recruitment maneuvers (protective ventilation strategy). Modified Clinical Pulmonary Infection Score, gas exchange, and pulmonary functional tests were measured preoperatively, as well as at days 1, 3, and 5 after surgery. Results: Patients ventilated protectively showed better pulmonary functional tests up to day 5, fewer alterations on chest x-ray up to day 3 and higher arterial oxygenation in air at days 1, 3, and 5 (mmHg; mean ± SD): 77.1 ± 13.0 versus 64.9 ± 11.3 (P = 0.0006), 80.5 ± 10.1 versus 69.7 ± 9.3 (P = 0.0002), and 82.1 ± 10.7 versus 78.5 ± 21.7 (P = 0.44) respectively. The modified Clinical Pulmonary Infection Score was lower in the protective ventilation strategy at days 1 and 3. The percentage of patients in hospital at day 28 after surgery was not different between groups (7 vs. 15% respectively, P = 0.42). Conclusion: A protective ventilation strategy during abdominal surgery lasting more than 2 h improved respiratory function and reduced the modified Clinical Pulmonary Infection Score without affecting length of hospital stay.

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PROtective Ventilation with a low versus high Inspiratory Oxygen fraction(PROVIO) and its effects on postoperative pulmonary complications:protocol for a randomized controlled trial

10.21203/rs.2.477/v1 ◽

2019 ◽

Author(s):

Xue-Fei Li ◽

Dan Jiang ◽

Yu-Lian Jiang ◽

Hong Yu ◽

Jia-Li Jiang ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Protective Ventilation ◽

Lung Protective Ventilation ◽

Ventilation Strategy ◽

Randomized Controlled ◽

Oxygen Fraction ◽

Protective Ventilation Strategy ◽

Lung Protective Ventilation Strategy ◽

Inspiratory Oxygen

Abstract Background Postoperative pulmonary complications (PPCs) have been the most common perioperative complication following surgical site infection, which prolongs the hospital stay and increases health care cost. Lung-protective ventilation strategy is considered better practice in abdominal surgery to prevent PPCs. The role of inspiratory oxygen fraction (FiO2) in the strategy is currently not clear and remains disputable, despite liberal oxygen administration and hyperoxia is demonstrated to be associated with respiratory mechanism changes and increased mortality in ventilated patients. The trial aims at exploring the effect of FiO2 in lung-protective ventilation strategy on PPCs. Methods PROtective Ventilation with a low versus high Inspiratory Oxygen fraction trial(PROVIO)is a single-center, prospective, randomized, controlled trial planning to recruit 252 patients under abdominal surgery lasting for at least 2 hours. The patients are randomly assigned to (1) a low FiO2 (30% FiO2) group and (2) a high FiO2 (80% FiO2) in lung-protective ventilation strategy. The primary outcome of the study is the occurrence of PPCs within the first 7 days postoperatively. Secondary outcomes include the severity grade of PPCs, the occurrence of postoperative extrapulmonary complications and all-cause mortality within the first 7 and 30 days postoperatively. Discussion PROVIO trial specially assesses the effect of low versus high FiO2 in lung-protective ventilation strategy on PPCs and the results will provide practical approaches to intraoperative oxygen management. Trial registration number Registered at www.ChiCTR.org.cn on 13 February 2018 with identifier no. ChiCTR18 00014901.

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Unsuccessful weaning from mechanical ventilation in children and ways to avoid it

Шпитальна хірургія Журнал імені Л Я Ковальчука ◽

10.11603/2414-4533.2020.3.11270 ◽

2020 ◽

pp. 82-89

Author(s):

O. V. Filyk

Keyword(s):

Mechanical Ventilation ◽

Protective Ventilation ◽

Lung Protective Ventilation ◽

Weaning From Mechanical Ventilation ◽

Ventilation Strategy ◽

Group I ◽

Protective Ventilation Strategy ◽

Elective Tracheostomy ◽

Group Ii ◽

Lung Protective Ventilation Strategy

The aim of the work: to determine causes of unsuccessful weaning depending on subglottic edema markers, level of sedation and sedation-agitation, changes in neurological status and bulbar disorders in children with different types of respiratory failure. Materials and Methods. We conducted a prospective cohort single-center study at the Department of Anesthesiology and Intensive Care at Lviv Regional Children's Clinical Hospital "OHMATDYT". We included 89 patients aged 1 month – 18 years with acute respiratory failure who was mechanically ventilated for more than 3 days. They were randomly divided into 2 groups. Group I included patients who received lung-protective ventilation strategy and assessment central nervous system function and the percentage of leakage of the gas mixture near the endotracheal tube; group II – patients who received diaphragm-protective in addition to lung-protective ventilation strategy and took into account the results of central nervous system assessment and respiratory gas mixture leakage near endotracheal tube during weaning from mechanical ventilation. The primary endpoint was the frequency of reintubations, the secondary endpoint was the frequency of complications (tracheostomy). 82 patients were included in the data analysis. Patients were divided into age subgroups: subgroup 1 – children 1 month – 1 year; subgroup – children 1–3 years; subgroup 3 – children 3–6 years; subgroup 4 – children 6–13 years; subgroup 5 – children 13–18 years. Results and Discussion. The frequency of reintubations in patients of the age subgroup 1 was reduced in group II to 5.3 % compared with 22.7 % in group I (p = 0.02), which was accompanied by a higher frequency of elective tracheostomy (before the first attempt of weaning from mechanical ventilation) which was 11 % in comparison with 0 %, p = 0.001). The frequency of reintubations in the age subgroup 2 was reduced to 5.9 % in group II vs 20 % in group I (p = 0.04), and elective tracheostomy was performed in 18 % patients in group II vs 5 % patients in group I (p = 0.05). There were no significant differences in the frequency of reintubations among patients in the age subgroup 3 (14.2 % in group I vs 11.1 % in group II, p = 0.31); in the age subgroup 4 (13 % vs 17 %, p = 0.19); the age subgroup 5 (6 % vs 7 %, p = 0.72).

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Lung-protective Ventilation in the Operating Room

Anesthesiology ◽

10.1097/aln.0000000000000274 ◽

2014 ◽

Vol 121 (1) ◽

pp. 184-188 ◽

Cited By ~ 27

Author(s):

Neil M. Goldenberg ◽

Benjamin E. Steinberg ◽

Warren L. Lee ◽

Duminda N. Wijeysundera ◽

Brian P. Kavanagh

Keyword(s):

Operating Room ◽

Protective Ventilation ◽

Practice Change ◽

Surgical Patients ◽

Lung Protective Ventilation ◽

Ventilation Strategy ◽

Protective Ventilation Strategy ◽

Lung Protective Ventilation Strategy

Abstract Recent data suggest that adopting a lung protective ventilation strategy will benefit healthy surgical patients. The authors examine the data, and suggest exercising caution prior to implementing a practice change that will affect a massive population.

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