Lung-protective mechanical ventilation for patients undergoing abdominal laparoscopic surgeries: a randomized controlled trial

Trung Kien Nguyen,Ngoc Quynh Nguyen,Chi Tue Nguyen,Dang Thu Nguyen,Truong Giang Nguyen,Quang Huy Nguyen,The Anh Vu,Viet Luong Nguyen,Anh Nguyet Le,Duc Hanh Mai

doi:10.1186/s12871-021-01318-5

Abstract

BackgroundPneumoperitoneum and Trendelenburg position in laparoscopic surgeries could contribute to postoperative pulmonary dysfunction. In recent years, intraoperative lung-protective mechanical ventilation (LPV) has been reportedly able to attenuate ventilator-induced lung injuries (VILI). Our objectives were to test the hypothesis that LPV could improve intraoperative oxygenation function, pulmonary mechanics and early postoperative atelectasis in laparoscopic surgeries.MethodsIn this randomized controlled clinical trial, 62 patients indicated for elective abdominal laparoscopic surgeries with an expected duration of greater than 2 h were randomly assigned to receive either lung-protective ventilation (LPV) with a tidal volume (Vt) of 7 ml kg− 1 ideal body weight (IBW), 10 cmH2O positive end-expiratory pressure (PEEP) combined with regular recruitment maneuvers (RMs) or conventional ventilation (CV) with a Vt of 10 ml kg− 1 IBW, 0 cmH2O in PEEP and no RMs. The primary endpoints were the changes in the ratio of PaO2 to FiO2 (P/F). The secondary endpoints were the differences between the two groups in PaO2, alveolar-arterial oxygen gradient (A-aO2), intraoperative pulmonary mechanics and the incidence of atelectasis detected on chest x-ray on the first postoperative day.ResultsIn comparison to CV group, the intraoperative P/F and PaO2 in LPV group were significantly higher while the intraoperative A-aO2 was clearly lower. Cdyn and Cstat at all the intraoperative time points in LPV group were significantly higher compared to CV group (p < 0.05). There were no differences in the incidence of atelectasis on day one after surgery between the two groups.ConclusionsLung protective mechanical ventilation significantly improved intraoperative pulmonary oxygenation function and pulmonary compliance in patients experiencing various abdominal laparoscopic surgeries, but it could not ameliorate early postoperative atelectasis and oxygenation function on the first day after surgery.Trial registrationhttps://www.clinicaltrials.gov/identifier: NCT04546932 (09/05/2020).

Highlights

Pneumoperitoneum and Trendelenburg position in laparoscopic surgeries could contribute to postoperative pulmonary dysfunction
Pneumoperitoneum and Trendelenburg position could contribute to atelectasis formation [1], in dependent regions [2] and elevate mechanical stress in pulmonary parenchyma [3], triggering significant perioperative pulmonary dysfunction
Ventilation patterns with high tidal volumes should overdistend noninjured lungs, thereby activating a local inflammation and coagulation reaction [6, 7].zero-positive end-expiratory pressure or low levels of positive end-expiratory pressure (PEEP) could induce repetitive collapse and reopening of the alveoli, which result in an inflammatory injury [8]

Summary

Introduction

Pneumoperitoneum and Trendelenburg position in laparoscopic surgeries could contribute to postoperative pulmonary dysfunction. Intraoperative lung-protective mechanical ventilation (LPV) has been reportedly able to attenuate ventilator-induced lung injuries (VILI) [9] by employing a low tidal volume (Vt) [10], an appropriate level of PEEP [11], and recruitment maneuvers (RMs) [12]. The goals of these interventions are to minimize alveolar overdistention, to prevent repeated collapse and reopening of alveoli and to reduce atelectasis

Objectives

Methods

Results

Conclusion