Abstract
BackgroundVentilator-induced lung injury is a major cause of postoperative pulmonary complications (PPCs) in patients undergoing neurosurgery after general anesthesia. However, there is no study on the effect of a lung-protective ventilation strategy in patients undergoing neurosurgery.MethodsThis is a single-center, randomized, parallel-group controlled trial which will be carried out at Beijing Tiantan Hospital, Capital Medical University. Three hundred and thirty-four patients undergoing intracranial tumor surgery will be randomly allocated to the control group and the protective-ventilation strategy group. In the control group, tidal volume (VT) will be set at 10–12 ml/kg of predicted body weight but PEEP and recruitment maneuvers will not be used. In the protective group, VT will be set at 6–8 ml/kg of predicted body weight, PEEP at 6–8 cmH2O, and a recruitment maneuver will be used intermittently. The primary outcome is pulmonary complications within 7 days postoperatively. Secondary outcomes include intraoperative brain relaxation, the postoperative complications within 30 days and the cost analysis.DiscussionThis study aims to determine if the protective, pulmonary-ventilation strategy decreases the incidence of PPCs in patients undergoing neurosurgical anesthesia. If our results are positive, the study will indicate whether the protective, pulmonary-ventilation strategy is efficiently and safely used in neurosurgical patients undergoing the craniotomy.Trial registrationClinicalTrials.gov, ID: NCT02386683. Registered on 18 October 2014.
Highlights
Ventilator-induced lung injury is a major cause of postoperative pulmonary complications (PPCs) in patients undergoing neurosurgery after general anesthesia
The results suggested that the use of low tidal volumes in non-acute respiratory distress syndrome (ARDS) patients efficiently and significantly improved the clinical prognosis
The anesthesiologist who is responsible for the anesthesia implementation will not Selection and withdrawal of participants Recruitment Participants will be recruited from the neurosurgical wards and identified by their presence on surgical lists
Summary
Ventilator-induced lung injury is a major cause of postoperative pulmonary complications (PPCs) in patients undergoing neurosurgery after general anesthesia. Pulmonary complications after mechanical ventilation are the essential reasons for death and disability for patients undergoing general anesthesia [2, 3]. Recent clinical and laboratory researchers have indicated that high-tidalvolume ventilation leads to alveolar over-inflation, partial pulmonary atelectasis, and ventilator-induced lung injury (VILI) [10, 11]. Animal experiments have confirmed that mechanical ventilation with a high tidal volume leads to acute lung injury in healthy lungs [12, 13], stimulation of cytokine production, release of inflammatory substances and inflammatory cell aggregation [14,15,16]
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