Evaluation of the influence of individualized protective ventilation on the lung mechanical properties

Authors

  • T.S. Kuzmenko Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine
  • S.I. Vorotyntsev Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine

DOI:

https://doi.org/10.22141/2224-0586.17.6.2021.242329

Keywords:

respiratory mechanic, individualized protective ventilation

Abstract

The work is devoted to the study of the influence of individualized protective ventilation support on pulmonary mecha-nics. The study included 47 patients who underwent open abdominal surgery under general anesthesia. All patients had a moderate to high risk of developing postoperative pulmonary complications by the ARISCAT scale. Intraoperatively, the impact of individualized protective ventilation on respiratory mechanics, namely Ppeak, Pplat, Pdrive, dynamic pulmonary compliance was assessed. Individualized protective respiratory support was ventilation with a tidal volume of 7 ml/kg of ideal body weight, with the selection of the optimal level of positive pressure at the end of exhalation (PEEP), focusing on dynamic pulmonary compliance and performing recruiting maneuver, and then in the case of a decrease in dynamic pulmonary compliance by more than 20 %, followed by re-selection of PEEP. The studied parameters were recorded before and after the recruiting maneuver, as well as on the 30th, 60th, 90th, 120th, 150th, 180th minutes after the recruiting maneuver, depending on the duration of the operation. The use of alveolar straightening techniques led to an improvement in pulmonary mechanics, namely, an increase in dynamic pulmonary compliance by 16 % and a decrease in Pdrive by 17 %. The intraoperative level of PEEP averaged 4 [4; 5] cm of water. No cases of hypoxemia or recurrence of recruiting maneuver were reported. The obtained results indicate that chosen technique of recruiting maneuver is effective and safe, and its use allows reducing the negative impact of mechanical ventilation. The study did not find a statistically significant correlation between the level of PEEP and the value of dynamic pulmonary compliance. Such data prove the need for individual selection of ventilation parameters according to the characteristics of the mechanical properties of each patient.

Downloads

Download data is not yet available.

References

Kor DJ, Warner DO, Alsara A, Fernández-Pérez ER et al. Derivation and Diagnostic Accuracy of the Surgical Lung Injury Prediction Model. Anesthesiology. 2011;115:117–128 doi: 10.1097/ALN.0b013e31821b5839.

Gropper MA. Postoperative Respiratory Muscle Dysfunction: Only the Strong Survive. Anesthesiology. 2013;118:783–784 doi:10.1097/ALN.0b013e318288823b.

Smith PR, Baig MA, Brito V, Bader F et al. Postoperative Pulmonary Complications after Laparotomy. Respiration. 2010;80:269-274. doi: 10.1159/000253881.

Nafiu OO, Ramachandran SK, Ackwerh R, Tremper KK et al. Factors associated with and consequences of unplanned post-operative intubation in elderly vascular and general surgery patients. European journal of anaesthesiology. 2011;28:220-224. doi: 10.1097/EJA.0b013e328342659c.

Ramachandran SK, Nafiu OO, Ghaferi A, Tremper KK et al. Independent predictors and outcomes of unanticipated early postoperative tracheal intubation after nonemergent, noncardiac surgery. Anesthesiology. 2011;115:44-53. doi: 10.1097/ALN.0b013e31821cf6de.

Fisher BW, Majumdar SR, McAlister FA. Predicting pulmonary complications after nonthoracic surgery: a systematic review of blinded studies. The American journal of medicine, 2002;112:219-225. doi: 10.1016/s0002-9343(01)01082-8.

Güldner A, Kiss T, Serpa Neto A, Hemmes SN et al. Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers. Anesthesiology. 2015;123:692-713. doi: 10.1097/ALN.0000000000000754.

Serpa Neto A, Hemmes SN, de Abreu MG, Pelosi P et al. PROVE Network investigators. Protocol for a systematic review and individual patient data meta-analysis of benefit of so-called lung-protective ventilation settings in patients under general anesthesia for surgery. Systematic Reviews. 2014;3:2. doi: 10.1186/2046-4053-3-2.

Ferrando C, Soro M, Unzueta C, Suarez-Sipmann F et al. Individualized PeRioperative Open-lung VEntilation (iPROVE) Network. Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial. The Lancet Respiratory Medicine. 2018;6:193-203. doi: 10.1016/S2213-2600(18)30024-9.

Serpa Neto A, Cardoso SO, Manetta JA, Pereira VG et al. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA. 2012;308:1651-1659. doi: 10.1001/jama.2012.13730.

Neto AS, Hemmes SN, Barbas CS, Beiderlinden M et al. PROVE Network Investigators. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data. The Lancet Respiratory Medicine. 2016;4:272-280. doi: 10.1016/S2213-2600(16)00057-6.

Young CC, Harris EM, Vacchiano C, Bodnar S et al. Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations. British Journal of Anaesthesia. 2019;123:898-913. doi: 10.1016/j.bja.2019.08.017.

Miskovic A, Lumb AB. Postoperative pulmonary complications. British Journal of Anaesthesia. 2017;118:317-334. doi: 10.1093/bja/aex002.

URL: https://medicalc.ru/devine (cited 07 February 2021)

Aoyama H, Yamada Y, Fan E. The future of driving pressure: a primary goal for mechanical ventilation? Journal of Intensive Care. 2018;6:64. doi: 10.1186/s40560-018-0334-4.

Wirth S, Baur M, Spaeth J, Guttmann J et al. Intraoperative positive end-expiratory pressure evaluation using the intratidal compliance-volume profile. British Journal of Anaesthesia.. 2015;114:483-490. doi: 10.1093/bja/aeu385.

Liu J, Meng Z, Lv R, Zhang Y et al.. Effect of intraoperative lung-protective mechanical ventilation on pulmonary oxygenation function and postoperative pulmonary complications after laparoscopic radical gastrectomy. Brazilian Journal of Medical Biological Research. 2019;52:e8523. doi: 10.1590/1414-431x20198523.

DESIGNATION–investigators, Bulte CSE. Driving Pressure During General Anesthesia for Open Abdominal Surgery (DESIGNATION): study protocol of a randomized clinical trial. Trials. 2020;21:198. https://doi.org/10.1186/s13063-020-4075-z.

Park M, Ahn HJ, Kim JA, Yang M et al. Driving Pressure during Thoracic Surgery: A Randomized Clinical Trial. Anesthesiology. 2019;130:385-393. doi: 10.1097/ALN.0000000000002600.

Published

2022-01-10

How to Cite

Kuzmenko, T., & Vorotyntsev, S. (2022). Evaluation of the influence of individualized protective ventilation on the lung mechanical properties. EMERGENCY MEDICINE, 17(6), 58–63. https://doi.org/10.22141/2224-0586.17.6.2021.242329

Issue

Section

Original Researches