scholarly journals Protective mechanical ventilation with optimal PEEP during RARP improves oxygenation and pulmonary indexes

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jianwei Zhou ◽  
Chuanguang Wang ◽  
Ran Lv ◽  
Na Liu ◽  
Yan Huang ◽  
...  
Keyword(s):  
Phase 1 ◽  
Lung Compliance ◽  
Protective Ventilation ◽  
Ventilation Strategy ◽  
Protective Group ◽  
Predicted Body Weight ◽  
Protective Ventilation Strategy ◽  
Steep Trendelenburg Position ◽  
Secondary Endpoints ◽  
The Difference

Abstract Background This trial aimed to evaluate the effects of a protective ventilation strategy on oxygenation/pulmonary indexes in patients undergoing robot-assisted radical prostatectomy (RARP) in the steep Trendelenburg position. Methods In phase 1, the most optimal positive end-expiratory pressure (PEEP) was determined in 25 patients at 11 cmH2O. In phase 2, 64 patients were randomized to the traditional ventilation group with tidal volume (VT) of 9 ml/kg of predicted body weight (PBW) and the protective ventilation group with VT of 7 ml/kg of PBW with optimal PEEP and recruitment maneuvers (RMs). The primary endpoint was the intraoperative and postoperative PaO2/FiO2. The secondary endpoints were the PaCO2, SpO2, modified clinical pulmonary infection score (mCPIS), and the rate of complications in the postoperative period. Results Compared with controls, PaO2/FiO2 in the protective group increased after the second RM (P=0.018), and the difference remained until postoperative day 3 (P=0.043). PaCO2 showed transient accumulation in the protective group after the first RM (T2), but this phenomenon disappeared with time. SpO2 in the protective group was significantly higher during the first three postoperative days. Lung compliance was significantly improved after the second RM in the protective group (P=0.025). The mCPIS was lower in the protective group on postoperative day 3 (0.59 (1.09) vs. 1.46 (1.27), P=0.010). Conclusion A protective ventilation strategy with lower VT combined with optimal PEEP and RMs could improve oxygenation and reduce mCPIS in patients undergoing RARP. Trial registration ChiCTR ChiCTR1800015626. Registered on 12 April 2018.

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

2005 ◽  
Vol 22 (Supplement 34) ◽  
pp. 1
Author(s):  
P. Michelet ◽  
A. Roch ◽  
B. Djourno ◽  
I. Decamps ◽  
P. Thomas ◽  
...  
Keyword(s):  
Systemic Inflammation ◽  
Protective Ventilation ◽  
Ventilation Strategy ◽  
Protective Ventilation Strategy

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

CHEST Journal ◽  
2011 ◽  
Vol 139 (3) ◽  
pp. 530-537 ◽  
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

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

2013 ◽  
Vol 118 (6) ◽  
pp. 1307-1321 ◽  
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.

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

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.

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

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).

scholarly journals Lung-protective Ventilation in the Operating Room

2014 ◽  
Vol 121 (1) ◽  
pp. 184-188 ◽  
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.

Effect of a Protective-Ventilation Strategy on Mortality in the Acute Respiratory Distress Syndrome

1998 ◽  
Vol 338 (6) ◽  
pp. 347-354 ◽  
Author(s):  
Marcelo Britto Passos Amato ◽  
Carmen Silvia Valente Barbas ◽  
Denise Machado Medeiros ◽  
Ricardo Borges Magaldi ◽  
Guilherme Paula Schettino ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Protective Ventilation ◽  
Ventilation Strategy ◽  
Protective Ventilation Strategy
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