Lung-protective mechanical ventilation for patients undergoing abdominal laparoscopic surgeries: a randomized...

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Thoracic Surgery

Background:

• Pneumoperitoneum and Trendelenburg positioning during laparoscopic surgery can impair postoperative lung function.
• Intraoperative lung-protective ventilation (LPV) strategies aim to mitigate ventilator-induced lung injuries (VILI).

Purpose of the Study:

• To evaluate the efficacy of LPV in enhancing intraoperative oxygenation and pulmonary mechanics.
• To assess the impact of LPV on early postoperative atelectasis in laparoscopic surgeries.

Main Methods:

• A randomized controlled trial involving 62 patients undergoing elective laparoscopic abdominal surgery.
• Patients were assigned to either LPV (tidal volume 7 mL/kg IBW, PEEP 10 cmH2O, recruitment maneuvers) or conventional ventilation (CV) (tidal volume 10 mL/kg IBW, PEEP 0 cmH2O, no recruitment maneuvers).
• Primary endpoint: change in PaO2/FiO2 ratio (P/F); Secondary endpoints: PaO2, alveolar-arterial oxygen gradient (A-aO2), pulmonary mechanics, and postoperative atelectasis incidence.

Main Results:

• The LPV group exhibited significantly higher intraoperative P/F ratio and PaO2 compared to the CV group.
• Intraoperative alveolar-arterial oxygen gradient (A-aO2) was significantly lower in the LPV group.
• Dynamic and static pulmonary compliance (Cdyn, Cstat) were significantly improved with LPV throughout the surgery.
• No significant difference in the incidence of postoperative atelectasis was observed between the groups on postoperative day one.

Conclusions:

• LPV effectively improves intraoperative pulmonary oxygenation and compliance in patients undergoing laparoscopic surgery.
• LPV does not appear to ameliorate early postoperative atelectasis or improve oxygenation on the first postoperative day.