Document Detail

Protective mechanical ventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function.
MedLine Citation:
PMID:  23542800     Owner:  NLM     Status:  MEDLINE    
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.
Paolo Severgnini; Gabriele Selmo; Christian Lanza; Alessandro Chiesa; Alice Frigerio; Alessandro Bacuzzi; Gianlorenzo Dionigi; Raffaele Novario; Cesare Gregoretti; Marcelo Gama de Abreu; Marcus J Schultz; Samir Jaber; Emmanuel Futier; Maurizio Chiaranda; Paolo Pelosi
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Anesthesiology     Volume:  118     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-05-22     Completed Date:  2013-07-22     Revised Date:  2014-03-04    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1307-21     Citation Subset:  AIM; IM    
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MeSH Terms
Abdomen / surgery*
Anesthesia, General / methods*
Follow-Up Studies
Intraoperative Care / methods*
Lung Diseases / prevention & control*
Positive-Pressure Respiration / methods
Postoperative Complications / prevention & control*
Postoperative Period
Prospective Studies
Respiration, Artificial / methods*
Respiratory Function Tests / methods,  statistics & numerical data
Tidal Volume
Treatment Outcome
Comment In:
Anesthesiology. 2014 Feb;120(2):512-4   [PMID:  24448087 ]
Anesthesiology. 2013 Jun;118(6):1254-7   [PMID:  23535504 ]
Anesthesiology. 2014 Feb;120(2):511-2   [PMID:  24448086 ]
Anesthesiology. 2014 Feb;120(2):509-10   [PMID:  24448084 ]
Anesthesiology. 2014 Feb;120(2):510-1   [PMID:  24448085 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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