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Variable versus conventional lung protective mechanical ventilation during open abdominal surgery: study protocol for

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Variable ventilation may improve lung function and reduce inflammation in patients undergoing major abdominal surgery. This study investigates its effects compared to conventional ventilation during general anesthesia.

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Area of Science:

  • Anesthesiology
  • Critical Care Medicine
  • Respiratory Physiology

Background:

  • Mechanical ventilation with constant tidal volumes is standard during general anesthesia.
  • Variable ventilation strategies show potential for lung recruitment and reduced inflammation in experimental models.
  • The benefit of intraoperative variable ventilation in open abdominal surgery remains unestablished.

Purpose of the Study:

  • To evaluate the efficacy of variable ventilation (VV) versus conventional ventilation (CV) in patients undergoing open abdominal surgery.
  • To assess the impact of VV on postoperative lung function and systemic inflammatory response.
  • To determine the role of VV in mechanical ventilation during general anesthesia.

Main Methods:

  • The PROtective VARiable ventilation (PROVAR) trial is a single-center, randomized controlled trial.
  • Enrolled 50 patients undergoing open abdominal surgery lasting over 3 hours.
  • Compared conventional lung protective ventilation (CV) with variable lung protective ventilation (VV).

Main Results:

  • Primary endpoint: Forced vital capacity on postoperative day 1.
  • Secondary endpoints: Lung function tests, plasma cytokine levels, ventilation distribution (electrical impedance tomography), and postoperative pulmonary complications.
  • Hypothesized improvement in lung function and reduction in inflammatory response with VV compared to CV.

Conclusions:

  • VV is hypothesized to improve lung function and reduce systemic inflammation compared to CV.
  • PROVAR is the first RCT to examine intra- and postoperative effects of VV on lung function.
  • This study aims to define the clinical utility of VV in general anesthesia requiring mechanical ventilation.