Protective ventilation strategy offers post-op lung benefits

Apr 25 2013

By Peter Sergo, medwireNews Reporter

Patients who receive a lung-protective ventilation strategy during abdominal surgery benefit from better respiratory function and fewer signs of infection afterward, a study finds.

"We showed that a protective ventilation strategy with lower tidal volumes, PEEP [positive end-expiratory pressure], and RMs [recruitment maneuvers] during anesthesia improved the respiratory function in the postoperative period after abdominal nonlaparoscopic surgery and reduced the clinical signs of pulmonary infection during the first 5 days after open abdominal surgery," write Paolo Severgnini (University of Insubria, Varese, Italy) and colleagues.

The researchers conducted a prospective randomized, open-label clinical trial involving 56 patients who were to undergo elective open abdominal surgery that would last beyond 2 hours.

Half of the patients underwent conventional standard mechanical ventilation with a tidal volume of 9 mL/kg ideal body weight and zero-PEEP while the other half experienced a protective strategy involving lower tidal volume (7 mL/kg ideal body weight), 10 cm H₂O PEEP, and intraoperative RMs.

Pulmonary assessments were made preoperatively, and 1, 3, and 5 days after surgery.

Patients who were ventilated protectively had fewer signs of pulmonary infection, with a significantly lower average modified Clinical Pulmonary Infection Score (mCPIS) on postoperative days 1 and 3, compared with the standard ventilation group.

Patients ventilated protectively also showed significantly higher peripheral blood oxygenation (SpO₂) than the standard group at postoperative days 1, 3, and 5. The former group had significantly lower SpO₂ than their preoperative level only on day 1, while the standard group had significantly lower levels on days 1, 3, and 5.

With regard to arterial oxygen pressure, those who were protectively ventilated had significantly higher levels than the standard group on days 1 and 3. Both groups had significantly lower levels than their preoperative levels on days 1, 3, and 5.

Dyspnea, secretions, and cough scores did not differ between the two groups on any of the postoperative days. Conversely, chest X-ray changes were significantly fewer on days 1 and 3 in the protective group.

There was no significant difference in the percentage of patients who remained in the hospital 28 days after surgery.

In an accompanying editorial, Marcos Vidal Melo (Harvard Medical School, Boston, Massachusetts, USA) and Matthias Eikermann (Duisburg-Essen University, Germany) describe Severgnini et al's study as a step toward providing "pathophysiology-oriented mechanical ventilation customized to specific patient subsets and to ultimately improve anesthetic and surgical outcomes."

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