TY - JOUR
T1 - Ventilation with high versus low peep levels during general anaesthesia for open abdominal surgery does not affect postoperative spirometry: A randomised clinical trial
AU - Treschan, Tanja A.
AU - Schaefer, Maximilian
AU - Kemper, Johann
AU - Bastin, Bea
AU - Kienbaum, Peter
AU - Pannen, Benedikt
AU - Hemmes, Sabrine N.
AU - de Abreu, Marcelo G.
AU - Pelosi, Paolo
AU - Schultz, Marcus J.
PY - 2017
Y1 - 2017
N2 - BACKGROUNDInvasive mechanical ventilation during general anaesthesia for surgery typically causes atelectasis and impairs postoperative lung function.OBJECTIVEWe investigated the effect of intraoperative ventilation with high positive end-expiratory pressure (PEEP) and recruitment manoeuvres (RMs) on postoperative spirometry.DESIGNThis was a preplanned, single-centre substudy of an international multicentre randomised controlled trial, the PROVHILO trial.SETTINGUniversity hospital from November 2011 to January 2013.PATIENTSNonobese patients scheduled for major abdominal surgery at a high risk of postoperative pulmonary complications (PPCs).INTERVENTIONIntraoperative low tidal volume ventilation with PEEP levels of 12cmH(2)O and RM (the high PEEP group) or with PEEP levels of 2cmH(2)O or less without RM (the low PEEP group).MAIN OUTCOME MEASURESTime-weighted averages (TWAs) of the forced expiratory volume in 1s (FEV1) and the forced vital capacity (FVC) up to postoperative day five.RESULTSThirty-one patients were allocated to the high PEEP group and 32 to the low PEEP group. No postoperative spirometry test results were available for 6 patients. In both groups, TWA of FEV1 and FVC until postoperative day five were lower than preoperative values. Postoperative spirometry test results were not different between the high and low PEEP group; Data are median [interquartile range], TWA FVC 1.8 [1.6 to 2.4] versus 1.7 [1.2 to 2.4] l (P=NS) and TWA FEV1 1.2 [1.1 to 2.5] versus 1.2 [0.9 to 1.9] l (P=NS). Patients who developed PPCs had lower FEV1 and FVC on postoperative day five; 1.1 [0.9 to 1.6] versus 1.6 [1.4 to 1.9] l (P=0.001) and 1.6 [1.2 to 2.6] versus 2.3 [1.7 to 2.6] l (P=0.036), respectively.CONCLUSIONPostoperative spirometry is not affected by PEEP and RM during intraoperative ventilation for open abdominal surgery in nonobese patients at a high risk of PPCs, but rather is associated with the development of PPCs.TRIAL REGISTRATIONClinicalTrials.gov NCT01441791
AB - BACKGROUNDInvasive mechanical ventilation during general anaesthesia for surgery typically causes atelectasis and impairs postoperative lung function.OBJECTIVEWe investigated the effect of intraoperative ventilation with high positive end-expiratory pressure (PEEP) and recruitment manoeuvres (RMs) on postoperative spirometry.DESIGNThis was a preplanned, single-centre substudy of an international multicentre randomised controlled trial, the PROVHILO trial.SETTINGUniversity hospital from November 2011 to January 2013.PATIENTSNonobese patients scheduled for major abdominal surgery at a high risk of postoperative pulmonary complications (PPCs).INTERVENTIONIntraoperative low tidal volume ventilation with PEEP levels of 12cmH(2)O and RM (the high PEEP group) or with PEEP levels of 2cmH(2)O or less without RM (the low PEEP group).MAIN OUTCOME MEASURESTime-weighted averages (TWAs) of the forced expiratory volume in 1s (FEV1) and the forced vital capacity (FVC) up to postoperative day five.RESULTSThirty-one patients were allocated to the high PEEP group and 32 to the low PEEP group. No postoperative spirometry test results were available for 6 patients. In both groups, TWA of FEV1 and FVC until postoperative day five were lower than preoperative values. Postoperative spirometry test results were not different between the high and low PEEP group; Data are median [interquartile range], TWA FVC 1.8 [1.6 to 2.4] versus 1.7 [1.2 to 2.4] l (P=NS) and TWA FEV1 1.2 [1.1 to 2.5] versus 1.2 [0.9 to 1.9] l (P=NS). Patients who developed PPCs had lower FEV1 and FVC on postoperative day five; 1.1 [0.9 to 1.6] versus 1.6 [1.4 to 1.9] l (P=0.001) and 1.6 [1.2 to 2.6] versus 2.3 [1.7 to 2.6] l (P=0.036), respectively.CONCLUSIONPostoperative spirometry is not affected by PEEP and RM during intraoperative ventilation for open abdominal surgery in nonobese patients at a high risk of PPCs, but rather is associated with the development of PPCs.TRIAL REGISTRATIONClinicalTrials.gov NCT01441791
U2 - https://doi.org/10.1097/EJA.0000000000000626
DO - https://doi.org/10.1097/EJA.0000000000000626
M3 - Article
C2 - 28306591
SN - 0265-0215
VL - 34
SP - 534
EP - 543
JO - European Journal of Anaesthesiology
JF - European Journal of Anaesthesiology
IS - 8
ER -