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Acute respiratory distress syndrome (ARDS) patients experiencing protective mechanical ventilation, is associated with a marked mortality reduction. However, the incidence of acute cor pulmonale (ACP) in ARDS patients has recently been reported to range between 22% and 25%, as well as a trend for higher mortality. Therefore, the mechanical ventilation strategy is proposed, not only based on the protection of the lung, but also focused on the impact on the right ventricle function. Currently, point-of-care ultrasound has been widely practiced in a variety of clinical setting, which plays more and more important role in the early detection and management of ARDS and its complications. A retrospective study concerning the incidence, pathophysiology and risk factors for ACP patients in ARDS was done to analysis the application of lung ultrasound and echocardiography combined with lung ultrasound in clinical hemodynamics monitoring, and so as to optimize the ventilation setting to protect the function of lung and right ventricle. Further exploration of effective improvement of the pulmonary vascular and right ventricle function the goal-directed ultrasound approach, and the diagnosis and treatment flow is expected.
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Objective To explore the effects of protective lung ventilation strategy applied from anesthesia induction period on lung compliance and oxygenation in patients undergoing gyneco-logical laparoscopic surgery.Methods A total of 60 female patients underwent gynecological laparo-scopic surgery were randomly divided into protective lung ventilation strategy beginning from induction group (group A),protective lung ventilation strategy beginning after intubation group (group B),conventional ventilation group (group C).All the three groups received intermittent posi-tive ventilation.The oxygen concentration was 100% and oxygen flow rate was 2 L/min,the inhalation and exhalation ratio was 1∶2.Group A was given low tidal volume+low PEEP+lung recruitment ma-neuver (from induction,i.e.after the disappearance of spontaneous breathing,take mask ventilation lasted for 5 minutes with a tidal volume of 6 ml/kg,respiratory rate was 1 6 times/min,PEEP was 5 cm H 2 O,which was applied every 30 min);group B was given low tidal volume+low PEEP+lung recruitment maneuver (before intubation:tidal volume was 10 ml/kg,respiratory rate was 10 times/min;after intubation:tidal volume was 6 ml/kg,respiratory rate was 1 6 times/min,PEEP was 5 cm H 2 O,which was applied every 30 min);group C:tidal volume was 10 ml/kg,respiratory rate was 10 times/min.Ppeak,Pmean,CL were recorded at induction (T0 ),after intubation (T1 ),30 min (T2 ),60 min (T3 )during operation,release of pneumoperitoneum (T4 ).The arterial blood gas analysis was performed at T0 ,T1 ,T3 and after extubation (T5 ).Then the oxygenation index (OI)and pulmonary shunt fraction (Qs/Qt)was calculated.Results The Ppeak and Pmean were significantly higher among the three groups after pneumoperitoneum (T1 ,T2 ,T3 ,T4 )compared with T0 (P <0.05),Ppeak of group C was significantly higher compared with that of group A and group B and Pmean at T2 increased significantly (P < 0.05 );The CL of three groups decreased obviously after pneumoperitoneu (P <0.05),CL of group C was lower significantly than that of group A and group B at T3 ,T4 (P <0.05)while the difference between group A and group B were not significant.The OI of the three groups decreased significantly after exthbation (P <0.05)and the difference among the three groups was not significant.Qs/Qt of three groups increased obviously at T3 and decreased at T5 (P <0.05),Qs/Qt of group C was higher significantly than that of group A and group B at T3 (P <0.05).Only one patient in group C got pulmonary infection.Conclusion Compared with conventional ventilation,the protective lung ventilation strategy can significantly improve the lung compliance and oxygenation function in the patients undergoing gynecological laparoscopic surgery.
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ventilation mode selection , which can reduce the incidence of postoperative pulmonary complications and improve patient ’ s outcomes . This paper reviewed and summarized the application of protective lung ventilation during general anesthesia .