Abstract
BackgroundThis trial aimed to evaluate the effects of a protective ventilation strategy on oxygenation/pulmonary indexes in patients undergoing robot-assisted radical prostatectomy (RARP) in the steep Trendelenburg position.MethodsIn phase 1, the most optimal positive end-expiratory pressure (PEEP) was determined in 25 patients at 11 cmH2O. In phase 2, 64 patients were randomized to the traditional ventilation group with tidal volume (VT) of 9 ml/kg of predicted body weight (PBW) and the protective ventilation group with VT of 7 ml/kg of PBW with optimal PEEP and recruitment maneuvers (RMs). The primary endpoint was the intraoperative and postoperative PaO2/FiO2. The secondary endpoints were the PaCO2, SpO2, modified clinical pulmonary infection score (mCPIS), and the rate of complications in the postoperative period.ResultsCompared with controls, PaO2/FiO2 in the protective group increased after the second RM (P=0.018), and the difference remained until postoperative day 3 (P=0.043). PaCO2 showed transient accumulation in the protective group after the first RM (T2), but this phenomenon disappeared with time. SpO2 in the protective group was significantly higher during the first three postoperative days. Lung compliance was significantly improved after the second RM in the protective group (P=0.025). The mCPIS was lower in the protective group on postoperative day 3 (0.59 (1.09) vs. 1.46 (1.27), P=0.010).ConclusionA protective ventilation strategy with lower VT combined with optimal PEEP and RMs could improve oxygenation and reduce mCPIS in patients undergoing RARP.Trial registrationChiCTR ChiCTR1800015626. Registered on 12 April 2018.
Highlights
This trial aimed to evaluate the effects of a protective ventilation strategy on oxygenation/pulmonary indexes in patients undergoing robot-assisted radical prostatectomy (RARP) in the steep Trendelenburg position
With regard to Cardiac output (CO) and stroke volume variation (SVV), except that CO was decreased at the positive end-expiratory pressure (PEEP) value of 15 cmH2O compared with the time point of PP (P=0.043), no obvious differences were observed at other PEEP levels (Fig. 3)
PaCO2 showed transient accumulation in the protective group after the first recruitment maneuvers (RMs) (T2), but this phenomenon disappeared with time
Summary
This trial aimed to evaluate the effects of a protective ventilation strategy on oxygenation/pulmonary indexes in patients undergoing robot-assisted radical prostatectomy (RARP) in the steep Trendelenburg position. Robotic techniques, robot-assisted radical prostatectomy (RARP), are well-received in urological surgery due to operative precision in the confined pelvic space [7, 8]. During the RARP operation, the patients are placed in the steep Trendelenburg position (20°–25°) because of robot setup requirements. This position, combined with carbon dioxide (CO2) pneumoperitoneum at. Most prostate cancer patients are aged and need prolonged mechanical ventilation because of the time-consuming RARP surgery, which has been defined as a risk factor for pulmonary injury [10]. Perioperative anesthesia management during RARP is a challenge in respiratory care
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
