Optimization of protective lung ventilation in thoracic surgery
https://doi.org/10.35401/2541-9897-2022-25-4-32-38
Abstract
Background: Today protective ventilation is the predominant ventilation methodology. It includes the use of low tidal volume, inspiratory pressure limitation, and the application of positive end-expiratory pressure. However, several retrospective studies have shown that tidal volume, inspiratory pressure, and Positive End-Expiratory Pressure (PEEP) are not associated with patients’ treatment outcomes, but could be associated only when they influence driving pressure.
Objective: Optimization of the strategy of protective one-lung ventilation under the control of driving pressure, to reduce early postoperative respiratory complications in patients operated for lung cancer.
Material and methods: A prospective controlled study was conducted on 110 patients undergoing extended anatomical lung resections with subsequent comparison of clinical results depending on the level of driving pressure during one-lung ventilation. Postoperative pulmonary complications based on the Melbourne scale that appeared within 3 days after surgery became the endpoint.
Results: A correlation was established between the level of driving pressure and the level of PaO2 in the intraoperative period – high inverse (r = – 0.901). The greatest value in the development of postoperative respiratory failure is driving pressure, exceeding 15 cm of water (Odds ratio = 18.25). In the first 3 days, postoperative pulmonary complications, determined by the Melbourne group scale, occurred in 9 (8.2%) patients in whom the driving pressure exceeded 15 cm of water, and in 3 patients (2.7%) with a driving pressure level less than 15 cm of water (p = 0.016).
Conclusion: Driving pressure excess with values of more than 15 cm of water significantly increases the incidence of postoperative pulmonary complications. Fixed PEEP will be inappropriate both high and low, and individualized PEEP titrated by CStat may reduce driving pressure and become the next step in protective one-lung ventilation.
About the Authors
V. A. Zhikharev
Scientific Research Institute – Ochapovsky Regional Clinical Hospital no. 1;
Kuban State Medical University
Russian Federation
Russian Federation
Vasiliy A. Zhikharev, Dr. Sci. (Med.), Resident Physician of the Department of Anesthesiology and Intensive Care no. 1, head of the Scientific Department of Innovative Methods of Intensive Care; Assistant of the Department of Anesthesiology, Resuscitation and Transfusiology, Faculty of Advanced
Training and Professional Retraining of Specialists
1 Maya str., 167, Krasnodar, 350086
A. S. Bushuev
Scientific Research Institute – Ochapovsky Regional Clinical Hospital no. 1
Russian Federation
Russian Federation
Alexander S. Bushuev, Cand. Sci. (Med.), Resident Physician of the Department of Anesthesiology and Resuscitation no. 1
1 Maya str., 167, Krasnodar, 350086
V. A. Koryachkin
Saint Petersburg State Pediatric Medical University
Russian Federation
Russian Federation
Viktor A. Koryachkin, Dr. Sci. (Med.), Professor, Department of Anesthesiology, Resuscitation and Pediatric Emergency
Saint Petersburg
V. A. Porhanov
Scientific Research Institute – Ochapovsky Regional Clinical Hospital no. 1;
Kuban State Medical University
Russian Federation
Russian Federation
Vladimir A. Porhanov, Academician of Russian Academy of Sciences, Dr. Sci. (Med.), Professor, Chief Doctor; Head of Department of Oncology with the Course of Thoracic Surgery, Faculty of Advanced Training and Professional Retraining of Specialists
1 Maya str., 167, Krasnodar, 350086
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Review
For citations:
Zhikharev V.A., Bushuev A.S., Koryachkin V.A., Porhanov V.A. Optimization of protective lung ventilation in thoracic surgery. Innovative Medicine of Kuban. 2022;(4):32-38. (In Russ.) https://doi.org/10.35401/2541-9897-2022-25-4-32-38
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