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

Jing Liu,Junran Xie,Gaojian Wang,Yaping Zhang,Zhipeng Meng,Ran Lv

doi:10.1590/1414-431x20198523

Abstract

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.

Highlights

Gastric cancer is among the most malignant tumors in China
The incidence of ventilator-induced lung injury (VILI) [3,4] and pulmonary complications remains high at approximately 20–40% of upper abdominal surgeries [5], and is the main factor that negatively affects patient survival and health-care costs [6]
positive end-expiratory pressure (PEEP), as an important component of Lung-protective ventilation (LPV), is generally applied in clinical practice, and an unsuitable PEEP value during surgery may cause a decrease in pulmonary dynamic compliance (Cdyn) and gas exchange disorder due to the hyperinflation of lungs and/or pulmonary atelectasis in patients with normal lungs

Summary

Introduction

Gastric cancer is among the most malignant tumors in China. It is a senile disease and its incidence increases with age [1]. The incidence of ventilator-induced lung injury (VILI) [3,4] and pulmonary complications remains high at approximately 20–40% of upper abdominal surgeries [5], and is the main factor that negatively affects patient survival and health-care costs [6]. LPV has shown advantages in patients with healthy lungs during general anesthesia [7,8], and has demonstrated better results in patients with complications, such as lung injury in intensive care units (ICUs) and acute respiratory distress syndrome (ARDS). PEEP, as an important component of LPV, is generally applied in clinical practice, and an unsuitable PEEP value during surgery may cause a decrease in pulmonary dynamic compliance (Cdyn) and gas exchange disorder due to the hyperinflation of lungs and/or pulmonary atelectasis in patients with normal lungs

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