scholarly journals Effects of intraoperative PEEP on postoperative pulmonary complications in patients undergoing robot-assisted laparoscopic radical resection for bladder cancer or prostate cancer: study protocol for a randomized controlled trial

2019 ◽  
Author(s):  
Zhen-feng ZHOU ◽  
Jun-biao FANG ◽  
Long CHEN ◽  
Hong-fa WANG ◽  
Yong-jian YU ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bladder Cancer ◽  
Laparoscopic Surgery ◽  
Length Of Stay ◽  
Radical Resection ◽  
Pulmonary Complications ◽  
Ventilation Strategy ◽  
Postoperative Pulmonary Complications ◽  
Robot Assisted ◽  
Protective Ventilation Strategy

Abstract Background: There are increasing studies shown that the use of a lung-protective ventilation strategy has a lung protection effect in patients undergoing abdominal surgery, however, the appropriate PEEP has not yet defined. Adopting a suitable PEEP may prevent PPCs. Robot-assisted laparoscopic surgery is the newest and most minimally invasive care for bladder cancer or prostate cancer. It is also necessary to consider the effects of trendelenburg position with pneumoperitoneum (PnP) on airway pressure and pulmonary function. The role of PEEP during the intraoperative period in preventing PCC for robot-assisted laparoscopic surgery is not clearly defined. Methods/design: A total number of 208 patients undergoing robot-assisted laparoscopic radical resection for bladder cancer or prostate cancer will be enrolled and randomized into a standard PEEP (6-8 cmH2O) group and a low PEEP (≤ 2 cm H2O) group. Both groups will receive an inspired oxygen fraction (FiO2) of 0.50 and a tidal volume of 8 ml/kg ideal body weight (IBW). Standard perioperative fluid management standardization and analgesic treatments will be applied in both groups. The primary endpoint was postoperative pulmonary complications within 7 days after surgery. Secondary endpoints will be: the modified clinical pulmonary infection score (mCPIS), postoperative extrapulmonary complications, postoperative surgical complications, intensive care unit (ICU) length of stay, hospital length of stay, thirty-day mortality. Discussion: This trial is aimed to assess the effects of low tidal volumes combined a intraoperative PEEP ventilation strategy on postoperative pulmonary complications in patients undergoing robot-assisted laparoscopic radical resection for bladder cancer or prostate cancer.

scholarly journals Effects of Intraoperative PEEP on Postoperative Pulmonary Complications in Patients Undergoing Robot-assisted Laparoscopic Radical Resection for Bladder Cancer or Prostate Cancer: Study Protocol for a Randomized Controlled Trial

2018 ◽  
Author(s):  
Zhen-feng Zhou ◽  
Jun-biao Fang ◽  
Long Chen ◽  
Hong-fa Wang ◽  
Yong-jian Yu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bladder Cancer ◽  
Laparoscopic Surgery ◽  
Length Of Stay ◽  
Radical Resection ◽  
Pulmonary Complications ◽  
Ventilation Strategy ◽  
Postoperative Pulmonary Complications ◽  
Robot Assisted ◽  
Protective Ventilation Strategy

Abstract Background: There are increasing studies shown that the use of a lung-protective ventilation strategy has a lung protection effect in patients undergoing abdominal surgery, however, the appropriate PEEP has not yet defined. Adopting a suitable PEEP may prevent PPCs. Robot-assisted laparoscopic surgery is the newest and most minimally invasive care for bladder cancer or prostate cancer. It is also necessary to consider the effects of trendelenburg position with pneumoperitoneum (PnP) on airway pressure and pulmonary function. The role of PEEP during the intraoperative period in preventing PCC for robot-assisted laparoscopic surgery is not clearly defined. Methods/design: A total number of 208 patients undergoing robot-assisted laparoscopic radical resection for bladder cancer or prostate cancer will be enrolled and randomized into a standard PEEP (6-8 cmH2O) group and a low PEEP (≤ 2 cm H2O) group. Both groups will receive an inspired oxygen fraction (FiO2) of 0.50 and a tidal volume of 8 ml/kg ideal body weight (IBW). Standard perioperative fluid management standardization and analgesic treatments will be applied in both groups. The primary endpoint was postoperative pulmonary complications within 7 days after surgery. Secondary endpoints will be: the modified clinical pulmonary infection score (mCPIS), postoperative extrapulmonary complications, postoperative surgical complications, intensive care unit (ICU) length of stay, hospital length of stay, thirty-day mortality. Discussion: This trial is aimed to assess the effects of low tidal volumes combined a intraoperative PEEP ventilation strategy on postoperative pulmonary complications in patients undergoing robot-assisted laparoscopic radical resection for bladder cancer or prostate cancer.

scholarly journals Effects of intraoperative PEEP on postoperative pulmonary complications in high-risk patients undergoing laparoscopic abdominal surgery: study protocol for a randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e028464
Author(s):  
Zhen-feng Zhou ◽  
Jun-biao Fang ◽  
Hong-fa Wang ◽  
Ying He ◽  
Yong-jian Yu ◽  
...  
Keyword(s):  
High Risk ◽  
Length Of Stay ◽  
Abdominal Surgery ◽  
Fluid Management ◽  
Pulmonary Complications ◽  
Hospital Length Of Stay ◽  
Lung Protective Ventilation ◽  
Postoperative Pulmonary Complications ◽  
Protective Ventilation Strategy ◽  
Registration Number

IntroductionPostoperative pulmonary complications (PPCs), strongly associated with higher mortality risk, can develop in up to 58% of patients undergoing abdominal surgery. More and more evidence shows that the use of a lung-protective ventilation strategy has a lung protection effect in patients undergoing abdominal surgery, however, the role of positive end-expiratory pressure (PEEP) during the intraoperative period in preventing PPCs for laparoscopic surgery is not clearly defined.Methods and analysisA total of 208 patients with a high risk of PPC, undergoing laparoscopic abdominal surgery, will be enrolled and randomised into a standard PEEP (6–8 cm H2O) group and a low PEEP (≤2 cm H2O) group. Both groups will receive a fraction of inspired oxygen of 0.50 and a tidal volume of 8 mL/kg ideal body weight (IBW). Standard perioperative fluid management and analgesic treatments are applied in both groups. The primary end point is PPC within 7 days after surgery. Secondary end points are the modified Clinical Pulmonary Infection Score, postoperative extrapulmonary complications, postoperative surgical complications, intensive care unit length of stay, hospital length of stay, 30-day mortality.Ethics and disseminationThe study was approved by the Ethics Committee of Zhejiang Provincial People’s Hospital (People’s Hospital of Hangzhou Medicine College) (registration number KY2018026) on 22 October 2018. The first participant was recruited on 15 April 2019 and the estimated completion date of the study is October 2021. The results of this trial will be submitted to a peer-reviewed journal.Trial registration numberhttp://www.chictr.org.cn, ID: ChiCTR1800019865. Registered on 2 December 2018; preresults.

scholarly journals Application of Positive End-Expiratory Pressure (PEEP) in Patients During Prolonged Gynecological Surgery

2019 ◽  
Vol 46 (1) ◽  
pp. 28-33
Author(s):  
V. Koritarova ◽  
S. Georgiev
Keyword(s):  
Postoperative Complications ◽  
Pulmonary Complications ◽  
Protective Ventilation ◽  
Control Group ◽  
Gynecological Surgery ◽  
Ventilation Strategy ◽  
Postoperative Pulmonary Complications ◽  
Protective Ventilation Strategy ◽  
Group A ◽  
Group B

Abstract Introduction: A lot of clinical studies have shown that during prolonged surgery protective ventilation strategy, including low tidal volume, PEEP and recruitment maneuvers (RM) can reduce the rate of postoperative pulmonary complications, which are the second most common cause for postoperative mortality. Therefore, it is important to investigate clinical methods for preventing them. The strategy of protective ventilation is easy and safe for the patients and inexpensive for application during prolonged surgery. Aims: The objective of this trial was to study whether application of PEEP in patients during prolonged gynecological surgery could decrease the postoperative complications. Material and Methods: We compared the rates of postoperative complications in patients after prolonged open gynecological surgery, who were divided into 2 groups – group A, which was the control group on non-protective ventilation (35 patients) and group B on protective ventilation (35 patients). The patients in the control group were ventilated with tidal volume (VT) of 8-10 ml/kg without PEEP and RM; the patients in group B were ventilated with VT = 6-8 ml/kg according to their Predicted Body Weight, with a PEEP of 6 cm H2O and RM, which consisted of applying continuous positive airway pressure of 30 cm H2O for 30 seconds. RM was performed after intubation, after every disconnection from ventilator and before extubation. The study was successfully performed without a need for a change in the type of ventilation strategy because of hypoxia or hemodynamic instability. Statistical nonparametric test (e.g. chi-square) was applied. Results: Total rate of all postoperative complications observed in both groups was 27,1%. We found a significant relationship between application of PEEP and lower rates of postoperative pulmonary complications in group A (39,4%) compared to group B (12,1%), lower rate of respiratory failure (33,3% in group A vs. 9,1% in group B -) and atelectasis (21,2% in group A vs. 0% in group B). Conclusion: The protective ventilation strategy (low VT, PEEP and RM) in patients during prolonged gynecological surgery can reduce the rate of postoperative pulmonary complications such as respiratory failure and atelectasis.

scholarly journals Intraoperative Mechanical Ventilation and Postoperative Pulmonary Complications after Cardiac Surgery

2019 ◽  
Vol 131 (5) ◽  
pp. 1046-1062 ◽  
Author(s):  
Michael R. Mathis ◽  
Neal M. Duggal ◽  
Donald S. Likosky ◽  
Jonathan W. Haft ◽  
Nicholas J. Douville ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Pulmonary Complications ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Ventilation Strategy ◽  
Postoperative Pulmonary Complications ◽  
Protective Ventilation Strategy ◽  
Ventilation Strategies

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Compared with historic ventilation strategies, modern lung-protective ventilation includes lower tidal volumes (VT), lower driving pressures, and application of positive end-expiratory pressure (PEEP). The contributions of each component to an overall intraoperative protective ventilation strategy aimed at reducing postoperative pulmonary complications have neither been adequately resolved, nor comprehensively evaluated within an adult cardiac surgical population. The authors hypothesized that a bundled intraoperative protective ventilation strategy was independently associated with decreased odds of pulmonary complications after cardiac surgery. Methods In this observational cohort study, the authors reviewed nonemergent cardiac surgical procedures using cardiopulmonary bypass at a tertiary care academic medical center from 2006 to 2017. The authors tested associations between bundled or component intraoperative protective ventilation strategies (VT below 8 ml/kg ideal body weight, modified driving pressure [peak inspiratory pressure − PEEP] below 16 cm H2O, and PEEP greater than or equal to 5 cm H2O) and postoperative outcomes, adjusting for previously identified risk factors. The primary outcome was a composite pulmonary complication; secondary outcomes included individual pulmonary complications, postoperative mortality, as well as durations of mechanical ventilation, intensive care unit stay, and hospital stay. Results Among 4,694 cases reviewed, 513 (10.9%) experienced pulmonary complications. After adjustment, an intraoperative lung-protective ventilation bundle was associated with decreased pulmonary complications (adjusted odds ratio, 0.56; 95% CI, 0.42–0.75). Via a sensitivity analysis, modified driving pressure below 16 cm H2O was independently associated with decreased pulmonary complications (adjusted odds ratio, 0.51; 95% CI, 0.39–0.66), but VT below 8 ml/kg and PEEP greater than or equal to 5 cm H2O were not. Conclusions The authors identified an intraoperative lung-protective ventilation bundle as independently associated with reduced pulmonary complications after cardiac surgery. The findings offer insight into components of protective ventilation associated with adverse outcomes and may serve as targets for future prospective interventional studies investigating the impact of specific protective ventilation strategies on postoperative outcomes after cardiac surgery.

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

2020 ◽  
Author(s):  
Bo Rim Kim ◽  
Seohee Lee ◽  
Hansu Bae ◽  
Minkyoo Lee ◽  
Jae-Hyon Bahk ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Lung Ultrasound ◽  
Controlled Trial ◽  
Pulmonary Complications ◽  
Alveolar Recruitment ◽  
Postoperative Pulmonary Complications ◽  
Trendelenburg Position ◽  
Alveolar Recruitment Maneuver ◽  
Ultrasound Score ◽  
Inspired Oxygen

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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