Vincent Généreux1, Michaël Chassé2, François Girard1, Nathalie Massicotte1, Carl Chartrand-Lefebvre3, Martin Girard4. 1. Department of Anaesthesiology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada. 2. Department of Medicine, Division of Critical Care, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Centre de Recherche, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada. 3. Centre de Recherche, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada. 4. Department of Anaesthesiology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Department of Medicine, Division of Critical Care, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Centre de Recherche, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada. Electronic address: martin.girard@umontreal.ca.
Abstract
BACKGROUND: During general anaesthesia, most patients develop atelectasis, which promotes postoperative pulmonary complications. RCTs that investigated perioperative lung protection have failed to reduce postoperative pulmonary complications consistently. Ultrasound imaging could help confirm the effects of different protective ventilatory strategies, but this has not been tested in trials. The objective of this study was to use ultrasonography to evaluate whether lung-protective ventilation measures reduce perioperative atelectasis. METHODS: We conducted a prospective, randomised patient- and assessor-blinded controlled trial in women undergoing open gynaecological surgery. Subjects were randomised to either lung protection or zero end-expiratory pressure (ZEEP; with no recruitment manoeuvres [RMs]). Lung protection entailed PEEP (7 cm H2O) and RMs every 30 min. Lung ultrasonography was undertaken at five predefined time points. The primary outcome was the difference in lung ultrasonography score (LUS) between groups before emergence; a lower LUS indicates better lung aeration. RESULTS: We recruited 45 women (34-85 yr old). Women randomised to lung protection had lower mean (standard deviation) LUS before emergence (6.1 [3.7]), compared with women randomised to ZEEP (11.7 [3.9]; 95% confidence interval for the difference between group means [-7.9 to -3.2]; P<0.0001). This difference did not persist after extubation, with similar mean LUSs in women who had received intraoperative lung protection (7.0 [4.1]), compared with women randomised to receive ZEEP (7.7 [3.1]). CONCLUSIONS: As assessed by lung ultrasonography, intraoperative PEEP/RMs decreased aeration loss during general anaesthesia. However, similar degrees of aeration loss were observed after tracheal extubation regardless of intraoperative ventilatory strategy. CLINICAL TRIAL REGISTRATION: NCT02055807.
RCT Entities:
BACKGROUND: During general anaesthesia, most patients develop atelectasis, which promotes postoperative pulmonary complications. RCTs that investigated perioperative lung protection have failed to reduce postoperative pulmonary complications consistently. Ultrasound imaging could help confirm the effects of different protective ventilatory strategies, but this has not been tested in trials. The objective of this study was to use ultrasonography to evaluate whether lung-protective ventilation measures reduce perioperative atelectasis. METHODS: We conducted a prospective, randomised patient- and assessor-blinded controlled trial in women undergoing open gynaecological surgery. Subjects were randomised to either lung protection or zero end-expiratory pressure (ZEEP; with no recruitment manoeuvres [RMs]). Lung protection entailed PEEP (7 cm H2O) and RMs every 30 min. Lung ultrasonography was undertaken at five predefined time points. The primary outcome was the difference in lung ultrasonography score (LUS) between groups before emergence; a lower LUS indicates better lung aeration. RESULTS: We recruited 45 women (34-85 yr old). Women randomised to lung protection had lower mean (standard deviation) LUS before emergence (6.1 [3.7]), compared with women randomised to ZEEP (11.7 [3.9]; 95% confidence interval for the difference between group means [-7.9 to -3.2]; P<0.0001). This difference did not persist after extubation, with similar mean LUSs in women who had received intraoperative lung protection (7.0 [4.1]), compared with women randomised to receive ZEEP (7.7 [3.1]). CONCLUSIONS: As assessed by lung ultrasonography, intraoperative PEEP/RMs decreased aeration loss during general anaesthesia. However, similar degrees of aeration loss were observed after tracheal extubation regardless of intraoperative ventilatory strategy. CLINICAL TRIAL REGISTRATION: NCT02055807.
Authors: Martin Girard; Marie-Hélène Roy Cardinal; Michaël Chassé; Sébastien Garneau; Yiorgos Alexandros Cavayas; Guy Cloutier; André Y Denault Journal: Front Med (Lausanne) Date: 2022-09-15
Authors: Charalampos Pierrakos; Marry R Smit; Laura A Hagens; Nanon F L Heijnen; Markus W Hollmann; Marcus J Schultz; Frederique Paulus; Lieuwe D J Bos Journal: Front Physiol Date: 2021-06-04 Impact factor: 4.566