Emmanuel Futier1, Samir Jaber. 1. aDepartment of Anesthesiology and Critical Care Medicine, Estaing Hospital, University Teaching Hospital of Clermont-Ferrand bRetinoids, Reproduction and Developmental Diseases (R2D2) Unit, EA 7281, Clermont-Ferrand cDepartment of Anaesthesiology and Critical Care Medicine B (DAR B), Institut National de la Santé et de la Recherche Médicale (INSERM U-1046), Saint Eloi Teaching Hospital, University Hospital of Montpellier, Montpellier, France.
Abstract
PURPOSE OF REVIEW: To provide the most recent and relevant clinical evidence regarding the use of prophylactic lung-protective mechanical ventilation in abdominal surgery. RECENT FINDINGS: Evidence is accumulating, suggesting an association between intraoperative mechanical ventilation strategy and postoperative pulmonary complications in patients undergoing abdominal surgery. Nonprotective ventilator settings, especially high tidal volume (>10-12 ml/kg), very low level of positive end-expiratory pressure (PEEP, <5 cm H2O), or no PEEP, may cause alveolar overdistension and repetitive tidal recruitment leading to ventilator-associated lung injury in patients with healthy lungs. Stimulated by the previous findings in patients with acute respiratory distress syndrome, the use of lower tidal volume ventilation is becoming increasingly more common in the operating room. However, lowering tidal volume, though important, is only part of the overall multifaceted approach of lung-protective mechanical ventilation. Recent data provide compelling evidence that prophylactic lung-protective mechanical ventilation using lower tidal volume (6-8 ml/kg of predicted body weight), moderate PEEP (6-8 cm H2O), and recruitment maneuvers is associated with improved functional or physiological and clinical postoperative outcome in patients undergoing abdominal surgery. SUMMARY: The use of prophylactic lung-protective ventilation can help in improving the postoperative outcome.
PURPOSE OF REVIEW: To provide the most recent and relevant clinical evidence regarding the use of prophylactic lung-protective mechanical ventilation in abdominal surgery. RECENT FINDINGS: Evidence is accumulating, suggesting an association between intraoperative mechanical ventilation strategy and postoperative pulmonary complications in patients undergoing abdominal surgery. Nonprotective ventilator settings, especially high tidal volume (>10-12 ml/kg), very low level of positive end-expiratory pressure (PEEP, <5 cm H2O), or no PEEP, may cause alveolar overdistension and repetitive tidal recruitment leading to ventilator-associated lung injury in patients with healthy lungs. Stimulated by the previous findings in patients with acute respiratory distress syndrome, the use of lower tidal volume ventilation is becoming increasingly more common in the operating room. However, lowering tidal volume, though important, is only part of the overall multifaceted approach of lung-protective mechanical ventilation. Recent data provide compelling evidence that prophylactic lung-protective mechanical ventilation using lower tidal volume (6-8 ml/kg of predicted body weight), moderate PEEP (6-8 cm H2O), and recruitment maneuvers is associated with improved functional or physiological and clinical postoperative outcome in patients undergoing abdominal surgery. SUMMARY: The use of prophylactic lung-protective ventilation can help in improving the postoperative outcome.
Authors: Benjamin Sadowitz; Sumeet Jain; Michaela Kollisch-Singule; Joshua Satalin; Penny Andrews; Nader Habashi; Louis A Gatto; Gary Nieman Journal: World J Crit Care Med Date: 2016-02-04