Effect of intraoperative lung-protective mechanical ventilation on pulmonary oxygenation function and postoperative pulmonary complications after laparoscopic radical gastrectomy

This study aimed to observe the effects of lung-protective ventilation (LPV) on oxygenation index (OI) and postoperative pulmonary complications (PPCs) after laparoscopic radical gastrectomy in middle-aged and elderly patients. A total of 120 patients who were scheduled to undergo laparoscopic radical gastrectomy with an expected time of >3 h were randomly divided into conventional ventilation (CV group) with tidal volume (TV) of 10 mL/kg without positive end-expiratory pressure (PEEP), and lung-protective ventilation (PV group) with 7 mL/kg TV and personal level of PEEP with regular recruitment maneuver every 30 min. Measurements of OI, modified clinical pulmonary infection score (mCPIS), and PPCs were assessed during the perioperative period. Fifty-seven patients in the CV group and 58 in the PV group participated in the data analysis. Patients in the PV group showed better pulmonary dynamic compliance, OI, and peripheral capillary oxygen saturation during and after surgery. The mCPIS was significantly lower in the PV group than in the CV group after surgery. The incidence rate of PPCs was lower in the PV group than in the CV group and the difference was significant in patients whose ventilation time was longer than 6 h in both groups. LPV during laparoscopic radical gastrectomy significantly improved pulmonary oxygenation function and reduced postoperative mCPIS and the incidence of PPCs during the early period after surgery of middle-aged and elderly patients, especially patients whose mechanical ventilation time was longer than 6 h.

Application of Protective Lung Ventilation During General Anesthesia / 中国微创外科杂志

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 .

Predisposing Factors of Postoperative Pulmonary Complication in Children with Congenital Heart Disease

PURPOSE: Postoperative care usually required 24-48 hours at intensive care unit (ICU) in children with congenital heart disease. More longer ICU stay may give more chances to produce the postoperative complications. Postoperative pulmonary complication is produced to a much higher incidence after longer immobilized state with keeping catheters and arterial and venous lines. So, we evaluated the predisposing factors those are oriented to ICU stay factors and age, hematologic abnormalities, hepatic dysfunction, infections during ICU care in children with congenital heart disease. METHODS: A retrospective review was performed of postoperative factors for children undergoing open heart surgery in intensive cardiac unit, Wonkwang medical cardiac center. A total of 193 pediatric patients who had cardiac surgery with cardiopulmonary bypass in a 10 year period from Jan. 1995 until Dec. 2004 were reviewed. After logistic regression test, predisposing factors were deemed significant if associated with a pulmonary complication with P<0.05. RESULTS: Children who fell postoperative pulmonary complication in our institution occupied 15% of 193 patients with congenital heart disease. Of all clinical factors considered, those significantly associated with postoperative pulmonary complication were as follows: high ALT level, longer duration of mechanical ventilation and arterial line maintenance. CONCLUSION: Prompt weaning of mechanical ventilation and removal of arterial line during ICU stay in children underwent open heart surgery may be necessary to decrease the risks of postoperative pulmonary complication.

The Effects of Preventive PEEP on Perioperative Pulmonary Functions in Patients Receiving Gastrectomy with a Kent Retractor / 대한마취과학회지

BACKGROUND: Postoperative pulmonary complications (PPCs) following upper abdominal surgery are common, and are associated with prolonged hospital stay even for cardiopulmonary healthy patients. The development of atelectasis and the unequal distribution of perfusion-ventilation during anesthesia and surgery, and perhaps the reappearance of these disturbances after surgery, are the main hypotheses used to explain postoperative hypoxemia and pulmonary complications. Atelectasis may be increased by using a Kent retractor, which retracts the abdominal wall and compresses the lung. This study evaluated the effect of preventive intraoperative positive end-expiratory pressure (PEEP) on perioperative oxygenation and complications in patients who receive gastrectomy with a Kent retractor. METHODS: Thirty eight cardiopulmonary healthy patients were randomly allocated to receive 0 (control), 5 or 10 cmH2O of PEEP during surgery. Arterial blood was obtained to evaluate arterial oxygenation and the unequal distribution of perfusion-ventilation by analyzing arterial oxygen tension and alveolar-arterial oxygen tension differences ((A-a)Do2) during the perioperative period. Pulmonary function and complications were also evaluated. RESULTS: Intraoperative arterial oxygenation improved for all patients receiving 5 or 10 cm H2O PEEP. In the control group, there was statistically significant decrease in PaO2 and increase in (A-a)Do2 after Kent retractor was applied, but the others did not show this effect (P<0.05). No differences in postoperative oxygenation, the incidence of pulmonary complications or pulmonary function were observed between the three groups. CONCLUSIONS: The application of PEEP was effective at improving oxygenation, and at preventing atelectasis and an unequal distribution of perfusion-ventilation during gastrectomy with a Kent retractor. However, the effects of PEEP did not extend beyond surgery.