Key result
Individualized lung-protective mechanical ventilation significantly improved pulmonary oxygenation function and reduced the incidence of post-operative pulmonary complications compared to conventional ventilation.
Why the study?
The benefits of an individualized level of PEEP during general anesthesia for laparoscopic total hysterectomy had not been clearly established.
Does individualized lung-protective mechanical ventilation improve pulmonary oxygenation function and reduce post-operative pulmonary complications in patients undergoing laparoscopic total hysterectomy?
RCT (n=87)
Double-blind
Computer-generated random allocation
No
Does individualized lung-protective mechanical ventilation improve pulmonary oxygenation function and reduce post-operative pulmonary complications in patients undergoing laparoscopic total hysterectomy?
Individualized lung-protective mechanical ventilation with personalized PEEP and alveolar recruitment maneuvers significantly improves pulmonary oxygenation and reduces post-operative pulmonary complications compared to conventional ventilation in patients undergoing laparoscopic total hysterectomy.
Answers are grounded in this paper and cite their sources.
May support individualized ventilation perioperatively; larger trials needed before practice change.
Laparoscopic total hysterectomy is performed by carbon dioxide insufflation, Trendelenburg position and mechanical ventilation of patients under general anesthesia. However, this may induce pulmonary atelectasis and/or hyperdistention of the lungs. Multiple studies have indicated that mechanical ventilation with the use of low tidal volumes, moderate positive end-expiratory pressure (PEEP) and regular alveolar recruitment maneuvers may improve post-operative outcomes. However, the benefits of an individualized level of PEEP have not been clearly established. In the present study, it was hypothesized that a moderate fixed PEEP may not suit all patients and an individually-titrated PEEP during anesthesia may improve the peri-operative pulmonary oxygenation function. The aim of the present study was to compare the pulmonary oxygenation function and post-operative pulmonary complications (PPCs) in patients receiving individualized lung-protective mechanical ventilation (LPV) vs. conventional ventilation (CV) during laparoscopic total hysterectomy. The present study was a randomized double-blinded clinical trial on 87 patients who were randomly divided to receive CV or protective ventilation (PV). An optimal individualized PEEP value was determined using a static pulmonary compliance-directed PEEP titration procedure. Pulmonary oxygenation function, serum inflammatory factors, including interleukin-8 and Clara cell protein 16, the incidence of PPCs and the post-operative length of stay were also determined. Patients in the PV group exhibited improved pulmonary oxygenation function during and after the operation. The total percentage of PPCs during the first 7 days after surgery was significantly lower in the PV group compared with those in the CV group. In conclusion, as compared to CV, intra-operative individualized LPV significantly improved pulmonary oxygenation function and reduced the incidence of PPCs during the first 7 days after laparoscopic total hysterectomy (Clinical trial registration no. ChiCTR1900027738).
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Liu et al. (2020) conducted an RCT in Patients undergoing elective laparoscopic total hysterectomy (n=87). Individualized lung-protective mechanical ventilation (LPV) vs. Conventional ventilation (Tidal volume of 9 ml/kg IBW, without PEEP or alveolar recruitment maneuvers) was evaluated on Change in pulmonary oxygenation function including oxygen index (OI) during the pre- and post-operative period (p=<0.05). Individualized lung-protective mechanical ventilation significantly improved pulmonary oxygenation function and reduced the incidence of post-operative pulmonary complications compared to conventional ventilation.
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