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March 27, 2013AnesthesiologyOpen Access

Protect the Lungs during Abdominal Surgery

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Key result

High-PEEP protective ventilation during abdominal surgery improves respiratory function and reduces clinical pulmonary infection scores.

  • n=28

Why the study?

Postoperative pulmonary complications after abdominal surgery are a leading cause of morbidity and mortality, and the optimal intraoperative mechanical ventilation strategy to minimize these complications is not well established.

Does a protective ventilatory strategy improve respiratory function and reduce pulmonary infection scores in patients undergoing moderate/large abdominal surgery?

Population

Patients undergoing moderate/large abdominal surgery lasting more than 2 hours

Comparison

Protective ventilatory strategy with physiological tidal volumes and high PEEP vs standard ventilation

Design

Editorial discussing a clinical study

Follow-up

5 days

Authors

MMMarcos F. Vidal MeloMEMatthias Eikermann

Discussion

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Member takes

Overview

May reduce postoperative pulmonary morbidity in abdominal surgery; leaves open confirmation in large RCTs with clinical endpoints.

Structured PICO

Does a protective ventilatory strategy improve respiratory function and reduce pulmonary infection scores in patients undergoing moderate/large abdominal surgery?

P
Population
28 patients undergoing moderate/large abdominal surgery lasting more than 2 hours without initial lung disease.
I
Intervention
Protective ventilatory strategy with physiological tidal volumes (7.7 ml/kg predicted body weight), high positive end-expiratory pressure (PEEP 10 cm H2O), and recruitment maneuvers
C
Comparator
Standard ventilation (tidal volumes 9.5 ml/kg predicted body weight, PEEP 0 cm H2O)
O
Outcome
Respiratory function and clinical pulmonary infection score in the days after surgerysurrogate

This editorial highlights that a protective mechanical ventilation strategy during abdominal surgery may reduce postoperative respiratory morbidity.

Limitations

  • Small study focused on most clinically obtained measurements
  • Technique used for pulmonary function testing is prone to bias related to insufficient blinding of the assessor
  • Protective ventilation group may have been composed of individuals with lower risk of postoperative respiratory failure
  • Small study size
  • Insufficient blinding of the assessor during pulmonary function testing
  • Possible baseline imbalance with the protective ventilation group having lower risk of postoperative respiratory failure

Cite This Study

Melo et al. (2013) conducted an editorial in Abdominal surgery (n=28). Protective ventilatory strategy (physiological tidal volumes and high PEEP) vs. Standard ventilation (PEEP 0 cm H2O, tidal volume 9.5 ml/kg) was evaluated on Respiratory function and clinical pulmonary infection score. A protective ventilatory strategy with physiological tidal volumes and high PEEP during abdominal surgery improved respiratory function and reduced clinical pulmonary infection scores.

synapsesocial.com/papers/6aabb513bf7b76dfa683514bhttps://doi.org/10.1097/aln.0b013e3182910309
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Protective Mechanical Ventilation during General Anesthesia for Open Abdominal Surgery Improves Postoperative Pulmonary Function2013 · 492 citations
  2. 2Low-volume ventilation causes peripheral airway injury and increased airway resistance in normal rabbits2002 · 141 citations
  3. 3Mechanical ventilation of isolated rat lungs changes the structure and biophysical properties of surfactant2002 · 59 citations
  4. 4The physical basis of ventilator-induced lung injury2010 · 108 citations
  5. 5Higher vs Lower Positive End-Expiratory Pressure in Patients With Acute Lung Injury and Acute Respiratory Distress Syndrome2010 · 1,486 citations