| Autor: |
Treschan, Tanja A., Schaefer, Maximilian, Kemper, Johann, Bastin, Bea, Kienbaum, Peter, Pannen, Benedikt, Hemmes, Sabrine N., de Abreu, Marcelo G., Pelosi, Paolo, Schultz, Marcus J., Abreu, Marcelo G de, PROVE Network Investigators |
| Zdroj: |
European Journal of Anaesthesiology (Cambridge University Press); Aug2017, Vol. 34 Issue 8, p534-543, 10p |
| Abstrakt: |
Background: Invasive mechanical ventilation during general anaesthesia for surgery typically causes atelectasis and impairs postoperative lung function.Objective: We investigated the effect of intraoperative ventilation with high positive end-expiratory pressure (PEEP) and recruitment manoeuvres (RMs) on postoperative spirometry.Design: This was a preplanned, single-centre substudy of an international multicentre randomised controlled trial, the PROVHILO trial.Setting: University hospital from November 2011 to January 2013.Patients: Nonobese patients scheduled for major abdominal surgery at a high risk of postoperative pulmonary complications (PPCs).Intervention: Intraoperative low tidal volume ventilation with PEEP levels of 12 cmH2O and RM (the high PEEP group) or with PEEP levels of 2 cmH2O or less without RM (the low PEEP group).Main Outcome Measures: Time-weighted averages (TWAs) of the forced expiratory volume in 1 s (FEV1) and the forced vital capacity (FVC) up to postoperative day five.Results: Thirty-one patients were allocated to the high PEEP group and 32 to the low PEEP group. No postoperative spirometry test results were available for 6 patients. In both groups, TWA of FEV1 and FVC until postoperative day five were lower than preoperative values. Postoperative spirometry test results were not different between the high and low PEEP group; Data are median [interquartile range], TWA FVC 1.8 [1.6 to 2.4] versus 1.7 [1.2 to 2.4] l (P = NS) and TWA FEV1 1.2 [1.1 to 2.5] versus 1.2 [0.9 to 1.9] l (P = NS). Patients who developed PPCs had lower FEV1 and FVC on postoperative day five; 1.1 [0.9 to 1.6] versus 1.6 [1.4 to 1.9] l (P = 0.001) and 1.6 [1.2 to 2.6] versus 2.3 [1.7 to 2.6] l (P = 0.036), respectively.Conclusion: Postoperative spirometry is not affected by PEEP and RM during intraoperative ventilation for open abdominal surgery in nonobese patients at a high risk of PPCs, but rather is associated with the development of PPCs.Trial Registration: ClinicalTrials.gov NCT01441791. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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