Abstract
BackgroundSecondary lung injury is the most common non-neurological complication after traumatic brain injury (TBI). Lung-protective ventilation (LPV) has been proven to improve perioperative oxygenation and lung compliance in some critical patients. This study aimed to investigate whether intraoperative LPV could improve respiratory function and prevent postoperative complications in emergency TBI patients.MethodsNinety TBI patients were randomly allocated to three groups (1:1:1): Group A, conventional mechanical ventilation [tidal volume (VT) 10 mL/kg only]; Group B, small VT (8 mL/kg) + positive end-expiratory pressure (PEEP) (5 cmH2O); and Group C, small VT (8 mL/kg) + PEEP (5 cmH2O) + recruitment maneuvers (RMs). The primary outcome was the incidence of total postoperative pulmonary complications; Secondary outcomes were intraoperative respiratory mechanics parameters and serum levels of brain injury markers, and the incidence of each postoperative pulmonary and neurological complication.ResultsSeventy-nine patients completed the final analysis. The intraoperative PaO2 and dynamic pulmonary compliance of Groups B and C were higher than those of Group A (P = 0.028; P = 0.005), while their airway peak pressure and plateau pressure were lower than those of group A (P = 0.004; P = 0.005). Compared to Group A, Groups B and C had decreased 30-day postoperative incidences of total pulmonary complications, hypoxemia, pulmonary infection, and atelectasis (84.0 % vs. 57.1 % vs. 53.8 %, P = 0.047; 52.0 % vs. 14.3 % vs. 19.2 %, P = 0.005; 84.0 % vs. 50.0 % vs. 42.3 %, P = 0.006; 24.0 % vs. 3.6 % vs. 0.0 %, P = 0.004). Moreover, intraoperative hypotension was more frequent in Group C than in Groups A and B (P = 0.007). At the end of surgery, the serum levels of glial fibrillary acidic protein and ubiquitin carboxyl-terminal hydrolase isozyme L1 in Group B were lower than those in Groups A and C (P = 0.002; P < 0.001). The postoperative incidences of neurological complications among the three groups were comparable.ConclusionsContinuous intraoperative administration of small VT + PEEP is beneficial to TBI patients. Additional RMs can be performed with caution to prevent disturbances in the stability of cerebral hemodynamics.Trial registrationChinese Clinical Trial Registry (ChiCTR2000038314), retrospectively registered on September 17, 2020.
Highlights
Secondary lung injury is the most common non-neurological complication after traumatic brain injury (TBI)
At T3, the median Arterial partial pressure of oxygen (PaO2), Arterial partial pressure of carbon dioxide (PaCO2), and Pulmonary dynamic compliance (Cdyn) in Groups B and C were higher than those in Group A (340.0 vs. 397.5 vs. 402.5 mmHg, P = 0.005; 40.0 vs. 44.0 vs. 42.0 mmHg, P = 0.025; 330.0 vs. 340.0 vs. 340.0 mL/cmH2O, P = 0.009), which was opposite to the median Airway peak pressure (Ppeak) and Airway plateau pressure (Pplat) (19.0 vs. 17.0 vs. 17.0 cmH2O, P = 0.012; 16.0 vs. 13.0 vs. 14.0 cmH2O, P = 0.003)
Our study investigated the effects of intraoperative Lung-protective ventilation (LPV) on respiratory function and the incidences of postoperative complications in emergency TBI patients
Summary
Secondary lung injury is the most common non-neurological complication after traumatic brain injury (TBI). Lung-protective ventilation (LPV) has been proven to improve perioperative oxygenation and lung compliance in some critical patients. This study aimed to investigate whether intraoperative LPV could improve respiratory function and prevent postoperative complications in emergency TBI patients. It was reported that 89 % of severe TBI patients experienced at least one non-neurological complication, of which 81 % developed respiratory dysfunction, including 23 % of respiratory failure cases. Respiratory complications are prevalent nonneurological disorders experienced after TBI [2]. Neural and humoral regulation after injury leads to an attenuated response of lung tissues to stress [3, 4], increasing the risk of pulmonary complications, especially pulmonary infection, neurogenic pulmonary edema (NPE), ventilator-associated lung injury (VALI), and atelectasis
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