Protective lung ventilation during general anesthesia: is there any evidence?

Silvia Coppola,Sara Froio,Davide Chiumello

doi:10.1186/cc13777

Silvia Coppola, Sara Froio + Show 1 more

Open Access

https://doi.org/10.1186/cc13777

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Abstract

In acute respiratory distress syndrome (ARDS) several studies have shown that mechanical ventilation with high tidal volume (VT) and low levels of positive end-expiratory pressure (PEEP) can promote ventilator-induced lung injury (VILI), thus increasing morbidity and mortality [1]. An open lung strategy, combining the use of low VT with adequate PEEP levels and recruitment maneuvers, has thus been recommended in ARDS patients [2–4]. In patients without ARDS admitted to intensive care units (ICUs), who required mechanical ventilation for at least 12 hours, the use of a high VT significantly increased the inflammatory response [5, 6]. In contrast to critically ill patients, during general anesthesia, mechanical ventilation is required only for a few hours, thus the beneficial effects of lung-protective ventilation remain questionable. Moreover, there are limited data from few randomized controlled trials with only small cohorts of enrolled patients.

Highlights

In acute respiratory distress syndrome (ARDS) several studies have shown that mechanical ventilation with high tidal volume (VT) and low levels of positive endexpiratory pressure (PEEP) can promote ventilatorinduced lung injury (VILI), increasing morbidity and mortality [1]
We provide a comprehensive picture of the current literature on lung-protective ventilation during general anesthesia in patients without ARDS, focusing on the applications of this strategy in patients undergoing abdominal, thoracic and cardiac surgery
Mechanical ventilation is necessary for patients during general anesthesia

Summary

Introduction

In acute respiratory distress syndrome (ARDS) several studies have shown that mechanical ventilation with high tidal volume (VT) and low levels of positive endexpiratory pressure (PEEP) can promote ventilatorinduced lung injury (VILI), increasing morbidity and mortality [1]. In contrast to the previous studies, Severgnini et al, comparing a lung protective mechanical ventilation consisting of a VT of 7 ml/kg ideal body weight with PEEP levels of 10 cmH2O and recruitment maneuvers versus a VT of 9 ml/kg without PEEP, showed beneficial effects of the lung-protective strategy during general anesthesia lasting more than 2 hours [26]. The lung-protective strategy significantly reduced the incidence of atelectasis (from 8.8 % to 5 %), postoperative acute lung injury (from 3.7 % to 0.9 %), ICU admission (from 9.4 % to 2.5 %) and length of hospital stay (from 14.5 ± 3.3 to 11.8 ± 4.1 days) These data were confirmed in a randomized study during elective lobectomy in which patients were ventilated with a high VT of 10 ml/kg without PEEP compared to a low VT of 6 ml/kg with 5 cmH2O of PEEP and pressure controlled ventilation [35]. Further studies with larger cohorts of patients are needed to confirm the still weak evidence in favor of lung-protective ventilation in cardiac anesthesia

Conclusions

32. Wilson WCBJ

37. De Somer F

Findings

45. The Acute Respiratory Distress Syndrome Network