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

Trung Kien Nguyen, Viet Luong Nguyen, Truong Giang Nguyen, Duc Hanh Mai, Ngoc Quynh Nguyen, The Anh Vu, Anh Nguyet Le, Quang Huy Nguyen, Chi Tue Nguyen, Dang Thu Nguyen, Trung Kien Nguyen, Viet Luong Nguyen, Truong Giang Nguyen, Duc Hanh Mai, Ngoc Quynh Nguyen, The Anh Vu, Anh Nguyet Le, Quang Huy Nguyen, Chi Tue Nguyen, Dang Thu Nguyen

Abstract

Background: Pneumoperitoneum and Trendelenburg position in laparoscopic surgeries could contribute to postoperative pulmonary dysfunction. In recent years, intraoperative lung-protective mechanical ventilation (LPV) has been reportedly able to attenuate ventilator-induced lung injuries (VILI). Our objectives were to test the hypothesis that LPV could improve intraoperative oxygenation function, pulmonary mechanics and early postoperative atelectasis in laparoscopic surgeries.

Methods: In this randomized controlled clinical trial, 62 patients indicated for elective abdominal laparoscopic surgeries with an expected duration of greater than 2 h were randomly assigned to receive either lung-protective ventilation (LPV) with a tidal volume (Vt) of 7 ml kg- 1 ideal body weight (IBW), 10 cmH2O positive end-expiratory pressure (PEEP) combined with regular recruitment maneuvers (RMs) or conventional ventilation (CV) with a Vt of 10 ml kg- 1 IBW, 0 cmH2O in PEEP and no RMs. The primary endpoints were the changes in the ratio of PaO2 to FiO2 (P/F). The secondary endpoints were the differences between the two groups in PaO2, alveolar-arterial oxygen gradient (A-aO2), intraoperative pulmonary mechanics and the incidence of atelectasis detected on chest x-ray on the first postoperative day.

Results: In comparison to CV group, the intraoperative P/F and PaO2 in LPV group were significantly higher while the intraoperative A-aO2 was clearly lower. Cdyn and Cstat at all the intraoperative time points in LPV group were significantly higher compared to CV group (p < 0.05). There were no differences in the incidence of atelectasis on day one after surgery between the two groups.

Conclusions: Lung protective mechanical ventilation significantly improved intraoperative pulmonary oxygenation function and pulmonary compliance in patients experiencing various abdominal laparoscopic surgeries, but it could not ameliorate early postoperative atelectasis and oxygenation function on the first day after surgery.

Trial registration: https://www.clinicaltrials.gov/identifier: NCT04546932 (09/05/2020).

Keywords: Low tidal volume; Lung-protective ventilation; Positive end-expiratory pressure; Recruitment maneuvers.

Conflict of interest statement

No author has any conflict of interest regarding the publication of this article.

Figures

Fig. 1
Fig. 1
Flow diagram of the process through the phases of the trial
Fig. 2
Fig. 2
Intraoperative EtCO2 in the two groups with interval of 15 min from T0 (after intubation) to T14 (3.5 h after intubation). Data are reported as mean ± SD. p < 0.05 versus CV group
Fig. 3
Fig. 3
Changes in intraoperative pulmonary dynamic compliance (Cdyn). Data are reported as mean ± SD. At all time points, the difference between the two groups was significant with p < 0.05. H0 (after intubation), H1 (30 min after pneumoperitoneum), H2 (1 h after pneumoperitoneum), H3 (2 h after pneumoperitoneum), Hkt (10 min after pneumoperitoneum stopped) and Hro (before extubation)
Fig. 4
Fig. 4
Changes in intraoperative pulmonary static compliance (Cstat). Data are reported as mean ± SD. At all time points, the difference between the two groups was significant with p < 0.05. H0 (after intubation), H1 (30 min after pneumoperitoneum), H2 (1 h after pneumoperitoneum), H3 (2 h after pneumoperitoneum), Hkt (10 min after pneumoperitoneum stopped) and Hro (before extubation)
Fig. 5
Fig. 5
Intraoperative driving pressure (DP) in the two groups. Data are reported as mean ± SD. At all time points, the difference between the two groups was significant with p < 0.05. H0 (after intubation), H1 (30 min after pneumoperitoneum), H2 (1 h after pneumoperitoneum), H3 (2 h after pneumoperitoneum), Hkt (10 min after pneumoperitoneum stopped) and Hro (before extubation)

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