scholarly journals Mechanical ventilation mode and postoperative pulmonary complications - a reply

Anaesthesia ◽  
2018 ◽  
Vol 73 (2) ◽  
pp. 253-254
Author(s):  
A. Bagchi ◽  
M. I. Rudolph ◽  
M. Eikermann
Keyword(s):  
Mechanical Ventilation ◽  
Pulmonary Complications ◽  
Postoperative Pulmonary Complications ◽  
Ventilation Mode

scholarly journals Pressure-controlled ventilation-volume guaranteed (PCV-VG) for postoperative pulmonary complications: a protocol for a systematic review with meta-analysis and trial sequential analysis

2021 ◽  
Author(s):  
Jianqiao Zheng ◽  
Li Du ◽  
Xiaoqian Deng ◽  
Lu Zhang ◽  
Jia Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Sequential Analysis ◽  
Pulmonary Complications ◽  
Trial Sequential Analysis ◽  
Postoperative Pulmonary Complications ◽  
Ventilation Mode ◽  
Controlled Ventilation ◽  
Pressure Controlled Ventilation ◽  
Pressure Controlled

Abstract BackgroundMore than 300 million major surgical procedures are performed worldwide yearly. Above 30% of patients undergoing surgery with mechanical ventilation may experience postoperative pulmonary complications (PPCs). PPCs are the main cause of perioperative morbidity and mortality and it can be decreased by optimizing the mechanical ventilation. Pressure-controlled ventilation-volume guaranteed (PCV-VG) is a new ventilation mode, which combines the advantages of volume-controlled ventilation and pressure-controlled ventilation, might reduce PPCs. The efficacy of PCV-VG for PPCs has not yet been systematically reviewed. Hence, we will conduct a systematic review to evaluate the efficacy of PCV-VG for PPCs. The aim of this protocol is to investigate the benefits of PCV-VG versus conventional ventilation mode for PPCs.MethodsWe will search PubMed, Web of Science, Cochrane Library, Ovid medline, Embase, China National Knowledge Infrastructure, Chinese BioMedical Literature, Wanfang and VIP databases from their inception until May 2021, to identify randomised controlled studies using related keywords. Simultaneously, clinical registration tests and gray literature will also be retrieved. Studies published in English or Chinese will be considered. The primary outcome will be the incidence of PPCs, secondary outcomes will be intraoperative parameters of respiratory and hemodynamic function. Data synthesis/statistical analyses will be performed using the Review Manager software (version 5.4) and Stata (version 16). Heterogeneity will be assessed by the standard chi-square test and I2 statistic. Two authors will independently search, extract data from and assess the risk bias of included studies according the Cochrane risk of bias tool. Trial sequential analysis will be used to control the risks of random errors. Funnel plots and Egger’s regression test will be used to assess the publication bias. Certainty of the evidence will be assessed by modified Jadad Scale.DiscussionThis study will systematically and comprehensively search literature and integrate evidence on the efficacy of PCV-VG for PPCs. Our results will help clinical decision-making and support the development of clinical practice guidelines.

scholarly journals Mechanical ventilation is controlled by volume or pressure during neurosurgery. Is there an advantage?

2021 ◽  
Vol 17 (8) ◽  
pp. 51-54
Author(s):  
R.O. Merza ◽  
Ya.M. Pidhirnyi
Keyword(s):  
Mechanical Ventilation ◽  
Pulmonary Ventilation ◽  
Intermittent Positive Pressure Ventilation ◽  
Pulmonary Complications ◽  
Volume Control ◽  
Positive Pressure ◽  
Postoperative Pulmonary Complications ◽  
Oxygen Fraction ◽  
Number Of Patients ◽  
Neurosurgical Patients

Background. One of the main technologies of modern anesthesiology is mechanical ventilation (MV). At present, the protective technology of MV is widely recognized. The feasibi-lity of using this technology in the operating room, especially in patients with intact lungs, is not so obvious. Most of the scientific sources that cover this problem relate to patients with abdominal pathology, and less coverage remains in patients with neurosurgical pathology. However, patients who are operated on for neurosurgical pathology belong to the group of patients of high surgical risk, which forced us to conduct this study. The study was aimed to examine the feasibility of using protective MV during surgery in neurosurgical patients. Materials and methods. We examined 46 patients who were hospitalized in KNP 8 MKL in Lviv for spinal pathology and who underwent surgery for vertebroplasty with spondylodesis. Patients were divided into two groups: in the first group (34 patients), MV was performed by S-IPPV technology — synchronized intermittent positive pressure ventilation with volume control; and in the second group (12 patients), MV was performed by PCV technology — controlled ventilation pressure. Results. We retrospectively determined the incidence of post-operative pulmonary complications (POPC) in patients of the first and second groups. Of the 34 patients of the first group, the signs of POPC were detected in 17 patients (50 %), and of 12 patients of the second group, POPC were detected in 4 patients (33.3 %). It should be noted that MV in patients of both groups did not differ in such parameters as respiratory rate, end-alveolar pressure, and the fraction of oxygen in the respiratory mixture. Conclusions. A relatively small number of patients clearly do not allow the conclusions to be drawn, but it should be noted that MV (especially volume-controlled) contributes to postoperative pulmonary complications in patients with intact lungs in the preoperative period. And pressure-controlled MV tends to reduce the incidence of postoperative pulmonary complications in the postoperative period. Given that respiration rate, end-alveolar expiratory pressure and oxygen fraction in the respiratory mixture were comparable in patients of both groups, it can be assumed that the factor influencing the incidence of POPC is the mechanics of pulmonary ventilation.

scholarly journals The Effect of Ultrasound-Guided Lung Recruitment Maneuvers On Atelectasis In Lung-Healthy Patients Undergoing Laparoscopic Gynecologic Surgery: a Randomized Controlled Trial

2021 ◽  
Author(s):  
Yi Liu ◽  
Jingyu Wang ◽  
Yong Wan ◽  
Yuan Geng ◽  
Yiran Zhang ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
General Anesthesia ◽  
Lung Ultrasound ◽  
Pulmonary Complications ◽  
Lung Recruitment ◽  
Gynecologic Surgery ◽  
Postoperative Pulmonary Complications ◽  
Ultrasound Guided ◽  
Recruitment Maneuvers ◽  
Laparoscopic Gynecologic Surgery

Abstract BackgroundAtelectasis is a major cause of hypoxemia during general anesthesia and postoperative pulmonary complications (PPCs).Some previous reported that the combined use of lung recruitment procedures (LRMs) and positive end-expiratory pressure (PEEP) in mechanical ventilation mode contributes to the avoidance of PPCs in patients after general anesthesia, while others suggest that the use of LRMs makes patients more susceptible to hemodynamic disturbances and lung injury, and is of limited potential to decrease the incidence of PPCs. From this perspective, controversy exists as to whether LRMs should be routinely applied to surgical patients. More importantly, corresponding clinical studies are also lacking. Therefore, this trial was conducted with the aim of solving the above problem.MethodsIn current clinical trial, patients undergoing laparoscopic gynecologic surgery with healthy lungs were randomized to the recruitment maneuvers group (RM group; 6 cm H2O PEEP and RMs) and the control group (C group; 6 cm H2O PEEP and no RMs). Lung ultrasound was performed on patients at five separate time points. During mechanical ventilation, patients in the RM group received ultrasound-guided pulmonary resuscitation when atelectasis was detected, while the C group did not intervene. Lung ultrasound scores were used to evaluate the incidence and severity of atelectasis.ResultsAfter LRMs, the incidence of atelectasis was significantly lower in the RM group (40%) than in the C group (80%) 15 minutes after arrival in the post-anesthesia care unit (PACU), and this difference did not persist for 24 hours after surgery. Meanwhile, postoperative pulmonary complications showed no difference between the two groups.ConclusionsThe combination of LRMs and PEEP decreased the incidence of atelectasis 15 minutes after admission to the PACU, but did not improve PPCs in adults with healthy lungs. Hence, for lung-healthy patients undergoing gynecological laparoscopic surgery, we do not recommend routine recruitment maneuvers. Trial registration: (prospectively registered): ChiCTR2000033529. Registered on 6/4/2020.

Incidence and risk factors for postoperative pulmonary complications in elective intracranial surgery

2008 ◽  
Vol 109 (2) ◽  
pp. 222-227 ◽  
Author(s):  
Luciana Carrupt Machado Sogame ◽  
Milena Carlos Vidotto ◽  
José Roberto Jardim ◽  
Sonia Maria Faresin
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Prolonged Mechanical Ventilation ◽  
Pulmonary Complications ◽  
Postoperative Pulmonary Complications ◽  
Duration Of Surgery ◽  
Level Of Consciousness ◽  
Type Of Surgery

Object It has been shown that craniotomy may lead to a decrease in lung volumes and arterial blood gas tensions as well as a change in the respiratory pattern. The purpose of this study was to determine the incidence of postoperative pulmonary complications (PPCs) and the mortality rate in patients who have undergone elective craniotomy and to evaluate the associations between preoperative and postoperative variables and PPCs in this population. Methods Two hundred thirty-six patients were followed up based on a protocol including a clinical questionnaire, physical examination and observation of clinical characteristics in the preoperative period, type of surgery performed, duration of surgery, time spent in the intensive care unit (ICU) and hospital, and the occurrence of any PPCs. Results Postoperative pulmonary complications occurred in 58 patients (24.6%) and 23 other patients (10%) died. Predicting factors for PPCs according to multivariate analyses were as follows: type of surgery performed (p < 0.0001), prolonged mechanical ventilation ≥ 48 hours (p < 0.0001), time spent in the ICU > 3 days (p < 0.0001), decrease in level of consciousness (p < 0.002), duration of surgery ≥ 300 minutes (p < 0.01), and previous chronic lung disease (p < 0.04). Conclusions The incidence from March 2003 to March 2005 of PPCs in patients who had undergone craniotomy was 25% and death occurred in 10%. Some risk factors for PPCs may be predicted such as the type of surgery performed, prolonged mechanical ventilation, a longer time in the ICU, a decreased level of consciousness, duration of surgery, and previous chronic lung disease.

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