Protective Ventilation – Severgnini Anesthesiology 2013

Short Citation: Anesthesiology 2013;118(6):1307-21.

PubMed PMID: 23542800

Full Citation: Severgnini P, Selmo G, Lanza C, Chiesa A, Frigerio A, Bacuzzi A, Dionigi G, Novario R, Gregoretti C, de Abreu MG, Schultz MJ, Jaber S, Futier E, Chiaranda M, Pelosi P. Protective mechanical ventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function. Anesthesiology 2013;118(6):1307-21.

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Study Size: 56

Study Population: Patients scheduled to undergo elective open abdominal surgery lasting more than 2 h.

Methods: Patients were assigned by envelopes to mechanical ventilation:
1. Standard Ventilation Strategy: tidal volumes of 9 ml/kg ideal body weight and zero PEEP, or
2. Protective Ventilation Strategy: tidal volumes of 7 ml/kg ideal body weight, 10 cm H2O PEEP, and recruitment maneuvers.

Primary Endpoint(s): Modified Clinical Pulmonary Infection Score, gas exchange, and pulmonary functional tests were measured preoperatively, as well as at days 1, 3, and 5 after surgery.

Findings: Patients ventilated protectively showed better pulmonary functional tests up to day 5, fewer alterations on chest x-ray up to day 3 and higher arterial oxygenation in air at days 1, 3, and 5 (mmHg; mean ± SD): 77.1 ± 13.0 versus 64.9 ± 11.3 (P = 0.0006), 80.5 ± 10.1 versus 69.7 ± 9.3 (P = 0.0002), and 82.1 ± 10.7 versus 78.5 ± 21.7 (P = 0.44) respectively. The modified Clinical Pulmonary Infection Score was lower in the protective ventilation strategy at days 1 and 3. The percentage of patients in hospital at day 28 after surgery was not different between groups (7 vs. 15% respectively, P = 0.42).

Authors' Conclusions: A protective ventilation strategy during abdominal surgery lasting more than 2 h improved respiratory function and reduced the modified Clinical Pulmonary Infection Score without affecting length of hospital stay.

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