Key result
Low tidal volume with PEEP and recruitment maneuvers increased postoperative exhaled nitric oxide in 56.5% of patients, whereas eNO decreased in 78.3% of patients in the other two groups (P=0.016).
Why the study?
Does low tidal volume with PEEP and recruitment maneuvers improve exhaled nitric oxide levels in geriatric patients undergoing abdominal surgery?
RCT (n=69)
Randomized
Does low tidal volume with PEEP and recruitment maneuvers improve exhaled nitric oxide levels in geriatric patients undergoing abdominal surgery?
Low tidal volume ventilation with PEEP and recruitment maneuvers may prevent small airway injury, as indicated by exhaled nitric oxide levels, in geriatric patients undergoing abdominal surgery.
Supports low tidal volume with PEEP and recruitment in geriatric abdominal surgery; extends RCT evidence linking ventilation strategy to perioperative eNO changes.
Exhaled nitric oxide (eNO) has been suggested to be a marker of small airway injury. We investigated the effects of different ventilation strategies on eNO. Sixty-nine patients who received elective open abdominal surgery under general anesthesia with more than 2 h of surgery duration were randomly divided into three groups: high tidal volume of 10-12 ml kg(-1) predicted body weight (PBW) with zero end-expiratory pressure (ZEEP) (high VT + ZEEP group); low tidal volume of 6-8 ml kg(-1) PBW with 8 cm H2O positive end-expiratory pressure (PEEP) (low VT + PEEP group); and low tidal volume of 6-8 ml kg(-1) PBW with 8 cm H2O PEEP and recruitment maneuvers (low VT + PEEP + RMs group). eNO, respiratory system compliance (Crs), oxygenation index, inflammatory mediators tumor necrosis factor-alpha (TNF-α), interleukin-1β (IL-1β), IL-8, prostaglandin E2 (PGE2) and PGF2a as well as pulmonary function were measured during the perioperative period. The postoperative eNO decreased in 78.3% of patients in the high VT + ZEEP group and low VT + PEEP group, and increased in 56.5% of patients in the low VT + PEEP + RMs group (P = 0.016). The Crs level in the high VT + ZEEP group significantly decreased with time but significantly increased in the low VT + PEEP + RMs group (P < 0.05). The oxygenation index, inflammatory mediators and pulmonary function did not statistically differ among the three groups. Compared with the low VT + PEEP + RMs group, the decreasing rate of postoperative eNO in the high VT + ZEEP and low VT + PEEP groups was higher, which may imply small airway injury during geriatric abdominal surgery.
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Cui et al. (2015) conducted an RCT in Geriatric abdominal surgery (n=69). Low tidal volume with PEEP and recruitment maneuvers vs. High tidal volume with ZEEP or low tidal volume with PEEP was evaluated on Postoperative exhaled nitric oxide (eNO) (p=0.016). Low tidal volume with PEEP and recruitment maneuvers increased postoperative exhaled nitric oxide in 56.5% of patients, whereas eNO decreased in 78.3% of patients in the other two groups (P=0.016).
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