Document Detail

Comparison of two ventilatory strategies in elderly patients undergoing major abdominal surgery.
MedLine Citation:
PMID:  19933173     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: 'Open lung' ventilation is commonly used in patients with acute lung injury and has been shown to improve intraoperative oxygenation in obese patients undergoing laparoscopic surgery. The feasibility of an 'open lung' ventilatory strategy in elderly patients under general anaesthesia has not previously been assessed. METHODS: 'Open lung' ventilation (recruitment manoeuvres, tidal volume 6 ml kg(-1) predicted body weight, and 12 cm H(2)O PEEP) (RM group) was compared with conventional ventilation (no recruitment manoeuvres, tidal volume 10 ml kg(-1) predicted body weight, and zero end-expiratory pressure) in elderly patients (>65 yr) undergoing major open abdominal surgery with regard to oxygenation, respiratory system mechanics, and haemodynamic stability. We also monitored the serum levels of the interleukins (IL)-6 and IL-8 before and after surgery to determine whether the systemic inflammatory response to surgery depends on the ventilatory strategy used. RESULTS: Twenty patients were included in each group. The RM group tolerated open lung ventilation without significant haemodynamic instability. Intraoperative Pa(o(2)) improved in the RM group (P<0.01) and deteriorated in controls (P=0.01), but postoperative Pa(o(2)) was similar in both groups. The RM group had improved breathing mechanics as evidenced by increased dynamic compliance (36%) and decreased airway resistance (21%). Both IL-6 and IL-8 significantly increased after surgery, but the magnitude of increase did not differ between the groups. CONCLUSIONS: A lung recruitment strategy in elderly patients is well tolerated and improves intraoperative oxygenation and lung mechanics during laparotomy.
T N Weingarten; F X Whalen; D O Warner; O Gajic; G J Schears; M R Snyder; D R Schroeder; J Sprung
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  British journal of anaesthesia     Volume:  104     ISSN:  1471-6771     ISO Abbreviation:  Br J Anaesth     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2009-12-16     Completed Date:  2010-01-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  16-22     Citation Subset:  IM    
Department of Anesthesiology and Anesthesia Clinical Research Unit, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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MeSH Terms
Abdomen / surgery*
Aged, 80 and over
Airway Resistance
Anesthesia, General / methods*
Carbon Dioxide / blood
Interleukin-6 / blood
Interleukin-8 / blood
Oxygen / blood
Partial Pressure
Positive-Pressure Respiration / methods
Postoperative Complications
Respiration, Artificial / methods*
Reg. No./Substance:
0/Interleukin-6; 0/Interleukin-8; 124-38-9/Carbon Dioxide; 7782-44-7/Oxygen

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