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

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.

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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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Perioperative lung-protective ventilation strategy reduces postoperative pulmonary complications in patients undergoing thoracic and major abdominal surgery

Korean Journal of Anesthesiology ◽

10.4097/kjae.2016.69.1.3 ◽

2016 ◽

Vol 69 (1) ◽

pp. 3 ◽

Cited By ~ 8

Author(s):

Sang-Heon Park

Keyword(s):

Abdominal Surgery ◽

Pulmonary Complications ◽

Protective Ventilation ◽

Major Abdominal Surgery ◽

Lung Protective Ventilation ◽

Ventilation Strategy ◽

Postoperative Pulmonary Complications ◽

Protective Ventilation Strategy ◽

Lung Protective Ventilation Strategy

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Intraoperative Mechanical Ventilation and Postoperative Pulmonary Complications after Cardiac Surgery

Anesthesiology ◽

10.1097/aln.0000000000002909 ◽

2019 ◽

Vol 131 (5) ◽

pp. 1046-1062 ◽

Cited By ~ 10

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.

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Lung protective ventilation strategy to reduce postoperative pulmonary complications (PPCs) in patients undergoing robot-assisted laparoscopic radical cystectomy for bladder cancer: A randomized double blinded clinical trial

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2020.110156 ◽

2021 ◽

Vol 71 ◽

pp. 110156

Author(s):

Dan Huang ◽

Shujing Zhou ◽

Zhangjie Yu ◽

Jie Chen ◽

Hong Xie

Keyword(s):

Clinical Trial ◽

Pulmonary Complications ◽

Protective Ventilation ◽

Lung Protective Ventilation ◽

Ventilation Strategy ◽

Postoperative Pulmonary Complications ◽

Robot Assisted ◽

Protective Ventilation Strategy ◽

Double Blinded ◽

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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A protective-ventilation strategy reduces pulmonary complications after cardiac surgery

Critical Care ◽

10.1186/cc10731 ◽

2012 ◽

Vol 16 (S1) ◽

Author(s):

F Galas ◽

A Leme ◽

J Almeida ◽

M Volpe ◽

R Ianotti ◽

...

Keyword(s):

Cardiac Surgery ◽

Pulmonary Complications ◽

Protective Ventilation ◽

Ventilation Strategy ◽

Protective Ventilation Strategy

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The Effect of Manual Lung Hyperinflation and Postural Drainage on Pulmonary Complications in Mechanically Ventilated Trauma Patients

Anaesthesia and Intensive Care ◽

10.1177/0310057x9802600503 ◽

1998 ◽

Vol 26 (5) ◽

pp. 492-496 ◽

Cited By ~ 45

Author(s):

G. Ntoumenopoulos ◽

A. Gild ◽

D. J. Cooper

Keyword(s):

Nosocomial Pneumonia ◽

Pulmonary Complications ◽

Control Group ◽

Trauma Patients ◽

Mechanically Ventilated ◽

Clinical Criteria ◽

Lung Hyperinflation ◽

Postural Drainage ◽

Group A ◽

Group B

This study questioned whether manual lung hyperinflation (MHI) and postural drainage reduced the incidence of nosocomial pneumonia or improved other outcome variables in mechanically ventilated trauma patients. Patients were withdrawn from the study if they developed nosocomial pneumonia according to a predetermined definition or on the clinical suspicion of nosocomial pneumonia by the attending intensivist. Of the 46 patients who fulfilled all the inclusion criteria and were enrolled into the study, 22 patients were randomized to group A (physiotherapy) and 24 patients to group B (control group). Twice as many patients were withdrawn in group B (8/24) compared with group A (4/22), although the differences were not statistically significant, [X2(1, 1) = 1.36, P = 0.24]. The length of time receiving mechanical ventilation and in the ICU was similar between the two groups and there were no differences in pulmonary dysfunction (“worst” daily PaO2/FiO2 ratio) between the two groups. There were no ICU deaths in either group. Physiotherapy as used in this study was not associated with a reduced incidence of nosocomial pneumonia based on standard clinical criteria. Nevertheless the trend to more frequent nosocomial pneumonia in the control patients suggests that a larger study in more severely injured patients with stricter clinical criteria for the definition of nosocomial pneumonia is indicated.

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Effectiveness of home-based preoperative pulmonary rehabilitation in COPD patients undergoing lung cancer resection

Tumori Journal ◽

10.1177/0300891619900808 ◽

2020 ◽

Vol 106 (3) ◽

pp. 203-211 ◽

Cited By ~ 2

Author(s):

Marco Rispoli ◽

Rosario Salvi ◽

Antonio Cennamo ◽

Davide Di Natale ◽

Giovanni Natale ◽

...

Keyword(s):

Blood Gas Analysis ◽

Rehabilitation Program ◽

Pulmonary Complications ◽

Gas Analysis ◽

Blood Gas ◽

Postoperative Pulmonary Complications ◽

Home Based ◽

Before And After ◽

Group A ◽

Group B

Objective: To investigate the effectiveness of a home-based preoperative rehabilitation program for improving preoperative lung function and surgical outcome of patients with chronic obstructive pulmonary disease (COPD) undergoing lobectomy for cancer. Methods: This was a prospective, observational, single-center study including 59 patients with mild COPD who underwent lobectomy for lung cancer. All patients attended a home-based preoperative rehabilitation program including a minimum of 3 sessions each week for 4 weeks. Each session included aerobic and anaerobic exercises. Participants recorded the frequency and the duration of exercise performed in a diary. The primary end point was to evaluate changes in lung function including predicted postoperative (PPO) forced expiratory volume in 1 second (FEV1), 6-minute walking distance test (6MWD), PPO diffusing capacity for carbon monoxide (DLCO) %, and blood gas analysis values before and after the rehabilitation program. Postoperative pulmonary complications were recorded and multivariable analysis was used to identify independent prognostic factors (secondary end point). Results: All patients completed the 4-week rehabilitation program. Thirteen of 59 (22%) patients (Group A) performed <3 sessions per week (mean sessions per week: 2.3±1.3); 46 of 59 (78%) patients (Group B) performed ⩾3 sessions per week (mean sessions per week: 3.5±1.6). The comparison of PPO FEV1% and 6MWD before and after rehabilitation showed a significant improvement only in Group B. No significant changes in PPO DLCO% or in blood gas analysis values were seen. Nine patients presented postoperative pulmonary complications, including atelectasis ( n = 6), pneumonia ( n = 1), respiratory failure ( n = 1), and pulmonary embolism ( n = 1). Group A presented higher number of postoperative pulmonary complications than Group B (6 vs 3; p = 0.0005). Multivariate analysis showed that the number of weekly rehabilitation sessions was the only independent predictive factor ( p = 0.001). Conclusions: Our simple and low-cost rehabilitation program could improve preoperative clinical function in patients with mild to moderate COPD undergoing lobectomy and reduce postoperative pulmonary complications. All patients should be motivated to complete at least 3 rehabilitation sessions per week in order to obtain significant clinical benefits. Our preliminary results should be confirmed by larger prospective studies.

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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/v3 ◽

2019 ◽

Author(s):

Xue-Fei Li ◽

Dan Jiang ◽

Yu-Lian Jiang ◽

Hong Yu ◽

Jia-Li Jiang ◽

...

Keyword(s):

Abdominal Surgery ◽

Controlled Trial ◽

Pulmonary Complications ◽

Protective Ventilation ◽

Lung Protective Ventilation ◽

Ventilation Strategy ◽

Oxygen Fraction ◽

Protective Ventilation Strategy ◽

Lung Protective Ventilation Strategy ◽

Inspiratory Oxygen

Abstract Background: Postoperative pulmonary complications (PPCs) is the most common perioperative complication following surgical site infection (SSI), which prolongs the hospital stay and increases health care cost. Lung-protective ventilation strategy is considered better practice in abdominal surgery to prevent PPCs. However, the role of inspiratory oxygen fraction (FiO₂) in the strategy remains disputable. Previous trials have focused on reducing SSI by increasing inhaled oxygen concentration but higher FiO₂ (80%) was found to be associated with a greater incidence of atelectasis and mortality in recent researches. The trial aims at evaluating the effect of different FiO₂ added to lung-protective ventilation strategy on the incidence of PPCs during general anesthesia for abdominal surgery. 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 undergoing abdominal surgery lasting for at least 2 hours. The patients will be randomly assigned to (1) a low FiO₂ (30% FiO₂) group and (2) a high FiO₂ (80% FiO₂) group in lung-protective ventilation strategy. The primary outcome of the study is the occurrence of PPCs within the postoperative 7 days. Secondary outcomes include the severity grade of PPCs, the occurrence of postoperative extrapulmonary complications and all-cause mortality within the postoperative 7 and 30 days. Discussion: PROVIO trial assesses the effect of low versus high FiO₂ added to lung-protective ventilation strategy on PPCs for abdominal surgery patients 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. Keywords: Postoperative pulmonary complications, Lung-protective ventilation, Fraction of inspired oxygen, Abdominal surgery.

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