Lung Protective Mechanic Ventilation Strategies in the Operating Room

Year 2018, , 79 - 85, 01.03.2018

Eyyüp Sabri Özden

https://doi.org/10.17343/sdutfd.281441

Abstract

A protective ventilation
strategy refers to the use of low VT (in the range of 4–8 mL/kg of the
predicted body weight) with positive end-expiratory pressure (PEEP), with or
without recruitment manoeuvres. Protective ventilation has been considered the
optimal practice in patients suffering from the acute respiratory distress
syndrome (ARDS).However, few human studies have assessed how to ventilate
healthy lungs in patients undergoing general anaesthesia.

Keywords

Protective Ventilation Strategies, Operating Room

Operasyon Odasında Akciğer Koruyucu Mekanik Ventilasyon Stratejileri

Abstract

Koruyucu ventilasyon stratejisi, rekruitment
manevraları olsun veya olmasın, pozitif 
ekspirasyon sonu basınç (PEEP) ile düşük Vt'nin (tahmin edilen vücut
ağırlığının 4-8 mL / kg aralığında) kullanımını ifade eder. Akut solunum
sıkıntısı sendromu (ARDS) olan hastalarda koruyucu ventilasyon en uygun uygulama
olarak düşünülmüştür. Ancak genel anestezi uygulanan hastalarda sağlıklı
akciğerlerin nasıl havalandırılacağına ilişkin az sayıda insan çalışması
yapılmıştır.

Keywords

Koruyucu Ventilasyon Stratejileri, Operasyon Odası

References

• 1. Serpa Neto A, Cardoso SO, Manetta JA, Pereira VG, Esposito DC, Pasqualucci Mde O et al. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA 2012;308:1651-9.
• 2. Serpa Neto A, Schultz MJ, Slutsky AS. Current concepts of protective ventilation during general anaesthesia. Swiss Med Wkly. 2015;145:w14211
• 3. Hess DR, Kondili D, Burns E, Bittner EA, Schmidt UH. A 5- year observational study of lung-protective ventilation in the operating room: A single-center experience. Journal of Critical Care 2013;28:533.e9-15
• 4. Futier E, Jaber S. Lung-protective ventilation in abdominal surgery. Curr Opin Crit Care 2014;20:426-30
• 5. Tao T, Bo L, Chen F, Xie Q, Zou Y, Hu B, et al. Effect of protective ventilation on postoperative pulmonary complications in patients undergoing general anaesthesia: a meta-analysis of randomised controlled trials. BMJ Open 2014;4:e005208. doi:10.1136/ bmjopen-2014-005208
• 6. Ventilation with lower tidal volumes as campared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 2000;342:1301-8.
• 7. Güldner A, Kiss T, Serpa Neto A, Hemmes SN, Canet J, Spieth P, et al. Intraoperative Protective Mechanical Ventilation for Prevention of Postoperative Pulmonary Complications A Comprehensive Review of the Role of Tidal Volume, Positive End-expiratory Pressure, and Lung Recruitment Maneuvers. Anesthesiology 2015;123: 692-713
• 8. Richard JC, Maggiore SM, Jonson B, Mancebo J, Lemaire F, Brochard L. Influence of tidal volume on alveolar recruitment. Respective role of PEEP and a recruitment maneuver. Am J Respir Crit Care Med 2001;163:1609-13.
• 9. Brower RG, Lanken PN, Macintyre N, Matthay MA, Morris A, Ancukiewicz M, et al. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 2004;351:327-36.
• 10. Park SJ, Kim BG, Oh AH, Han SH, Han HS, Ryu JH. Effects of intraoperative protective lung ventilation on postoperative pulmonary complications in patients with laparoscopic surgery: prospective, randomized and controlled trial. Surg Endosc 2016 DOI 10.1007/s00464-016-4797-x
• 11. Schultz MJ, Haitsma JJ, Slutsky AS, Gajic O. What tidal volumes should be used in patients without acute lung injury? Anesthesiology 2007;106:1226–31
• 12. Hong CM, Xu DZ, Lu Q, Cheng Y, Pisarenko V, Doucet D, et al. Low Tidal Volume and High Positive End-Expiratory Pressure Mechanical Ventilation Results in Increased Inflammation and Ventilator-Associated Lung Injury in Normal Lungs. Anesth Analg 2010;110:1652-60
• 13. Crotti S, Mascheroni D, Caironi P, Pelosi P, Ronzoni G, Mondino M, et al. Recruitment and derecruitment during acute respiratory failure: A clinical study. Am J Respir Crit Care Med 2001;164:131-40.
• 14. Gattinoni L, Tognoni G, Pesenti A, Taccone P, Mascheroni D, Labarta V, et al. Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med 2001;345:568-73.
• 15. Licker M, Diaper J, Ellenberger C. Perioperative protective ventilatory strategies in patients without acute lung injuries. Anesthesiology 2008;108:335-6
• 16. Fernández-Pérez ER, Keegan MT, Brown DR, Hubmayr RD, Gajic O. Intraoperative tidal volume as a risk factor for respiratory failure after pneumonectomy. Anesthesiology 2006;105:14-8
• 17. Michelet P, D'Journo XB, Roch A, Doddoli C, Marin V, Papazian L, et al. Protective ventilation influences systemic inflammation after esophagectomy: a randomized controlled study. Anesthesiology 2006;105:911-9
• 18. Whalen FX, Gajic O, Thompson GB, Kendrick ML, Que FL, Williams BA, et al. The effects of the alveolar recruitment maneuver and positive end-expiratory pressure on arterial oxygenation during laparoscopic bariatric surgery. Anesth Analg 2006;102: 298-305
• 19. Chalhoub V, Yazigi A, Sleilaty G, Haddad F, Noun R, Madi-Jebara S, et al. Effect of vital capacity maneuvres on arterial oxygenation in morbidly obese patients undergoing open bariatric surgery. EJA 2007;24:283-8
• 20. Yang D, Grant MC, Stone A, Wu CL, Wick EC. A Meta-analysis of intraoperative ventilation strategies to prevent pulmonary complications. Is low tidal volüme alone sufficient to protect healthy lungs? Ann Surg 2016;263:881-7
• 21. Park SH. Perioperative lung-protective ventilation strategy reduces postoperative pulmonary complications in patients undergoing thoracic and major abdominal surgery. Korean J Anesthesiol 2016;69(1):3-7