Lung Protective Ventilation in the Operating Room

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Lung Protective Ventilation in theOperating Room (OR)

Jiapeng Huang MD

  Survival is improvedwhen lower tidal volumes (VT) (5-7ml/kg ideal body weight) are usedin patients with acutely diseases lungs in the ICU. Recent studies showed thathigher VT cause lung injuries in normal lungs and recommendationshave been made to use lower VT in all patients undergoing generalanesthesia.

  In the ICU,mechanical ventilation can cause barotrauma, volutrauma and biotrauma. In 2000,a landmark randomized trial demonstrated that lower VT improvessurvival in ventilated patients with acute respiratory distress syndrome. Maintenanceof lung volume is also important with adoption of recruitment maneuver andpositive end-expiratory pressure (PEEP).

  In the OR, a recentrandomized trial of 400 patients undergoing abdominal surgeries reported that lowerVT, PEEP and recruitment maneuver every 30 minutes during anesthesiaresulted in a better postoperative outcome (60% reduction) with lesspostoperative noninvasive ventilation, sepsis and shorter length of stay.Protective ventilation is beneficial when both lower VT and arecruitment strategy are included, but not when lower VT is usedalone. Lower VT during general anesthesia alone without a volumerecruitment strategy will cause progressive atelectasis, impaired lungcompliance and oxygenation.

  Should we implementlower VT and recruitment in the OR immediately since it is simple,inexpensive and seems to cause major reduction in postoperative morbidity?Large scale randomized trials in different surgical populations are still neededto confirm this promising finding. Anesthesiologists probably should restrictapplication of protective lung ventilation only in abdominal surgical patientsfor now.

Reference

1. Goldenberg NM, Steinberg BE, Lee WL, Wijeysundera DN,Kavanagh BP. Lung-Protective Ventilation in the Operating Room. Anesthesiology,2014;121;184-8.

Lung Protective Ventilation: 保护性通气。指低潮气容积（Tidal Volume)通气。

Recruitment Maneuver：肺复张策略。指间歇性进行短暂的肺正压扩张。目的使大多数肺泡扩张。

PEEP： 呼气末正压。可增加功能残气量，使肺泡再呼气末不易陷闭。

心在曹营

欢迎大家翻译成中文！

心在曹营

欢迎大家翻译成中文！

printhome

It's a good topic here. We published a meta-analysis this year to evaluate the effects of lung protective ventilation strategy in surgery. Studies published in Anesthesiology and NEJM these two years were also included. We do agree with the points above and applied these strategy in our clinical practise.