Ventilation with high versus low peep levels during general anaesthesia for open abdominal surgery does not affect postoperative spirometry: A randomised clinical trial
Ventilation with high versus low peep levels during general anaesthesia for open abdominal surgery does not affect postoperative spirometry: A randomised clinical trial
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开腹手术全身麻醉期间高呼气水平与低呼气水平的通气不会影响术后肺活量测定：一项随机临床试验
DOI：
10.1097/eja.0000000000000626
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发表时间：
2017
影响因子：
3.6
通讯作者：
M. Schultz
中科院分区：
文献类型：
--
作者：
T. Treschan;M. Schaefer;J. Kemper;B. Bastin;P. Kienbaum;B. Pannen;S. Hemmes;M. G. de Abreu;P. Pelosi;M. Schultz
背景：手术全麻期间有创机械通气通常会导致肺不张和术后肺功能受损。目的探讨术中高呼气末正压通气（PEEP）和复吸操作（RMs）对术后肺活量测定的影响。设计：这是一项国际多中心随机对照试验PROVHILO的预先计划的单中心亚研究。2011年11月至2013年1月在大学医院工作。患者：计划进行腹部大手术的非肥胖患者术后肺部并发症（PPCs）的高风险。干预措施术中低潮气量通气，PEEP水平为12 cmH2O和RM（高PEEP组）或PEEP水平为2 cmH2O或更低，无RM（低PEEP组）。主要观察指标1 s内用力呼气量（FEV1）和术后第5天用力肺活量（FVC）的时间加权平均值（TWAs）。结果高PEEP组31例，低PEEP组32例。6例患者术后无肺活量测定结果。两组患者术后第5天FEV1和FVC的TWA均低于术前。高PEEP组与低PEEP组术后肺活量测定结果无显著差异；数据为中位数[四分位数范围]，TWA FVC 1.8[1.6至2.4]vs . 1.7[1.2至2.4]l (P = NS), TWA FEV1 1.2[1.1至2.5]vs . 1.2[0.9至1.9]l （P = NS）。发生PPCs的患者术后第5天FEV1和FVC较低；分别为1.1[0.9 ~ 1.6]对1.6 [1.4 ~ 1.9]l （P = 0.001）和1.6[1.2 ~ 2.6]对2.3 [1.7 ~ 2.6]l （P = 0.036）。结论非肥胖腹部直视手术患者术中通气时肺量测定不受PEEP和RM的影响，但与PPCs的发生有关。临床试验注册：ClinicalTrials.gov NCT01441791。
BACKGROUND Invasive mechanical ventilation during general anaesthesia for surgery typically causes atelectasis and impairs postoperative lung function. OBJECTIVE We investigated the effect of intraoperative ventilation with high positive end-expiratory pressure (PEEP) and recruitment manoeuvres (RMs) on postoperative spirometry. DESIGN This was a preplanned, single-centre substudy of an international multicentre randomised controlled trial, the PROVHILO trial. SETTING University hospital from November 2011 to January 2013. PATIENTS Nonobese patients scheduled for major abdominal surgery at a high risk of postoperative pulmonary complications (PPCs). INTERVENTION Intraoperative low tidal volume ventilation with PEEP levels of 12 cmH2O and RM (the high PEEP group) or with PEEP levels of 2 cmH2O or less without RM (the low PEEP group). MAIN OUTCOME MEASURES Time-weighted averages (TWAs) of the forced expiratory volume in 1 s (FEV1) and the forced vital capacity (FVC) up to postoperative day five. RESULTS Thirty-one patients were allocated to the high PEEP group and 32 to the low PEEP group. No postoperative spirometry test results were available for 6 patients. In both groups, TWA of FEV1 and FVC until postoperative day five were lower than preoperative values. Postoperative spirometry test results were not different between the high and low PEEP group; Data are median [interquartile range], TWA FVC 1.8 [1.6 to 2.4] versus 1.7 [1.2 to 2.4] l (P = NS) and TWA FEV1 1.2 [1.1 to 2.5] versus 1.2 [0.9 to 1.9] l (P = NS). Patients who developed PPCs had lower FEV1 and FVC on postoperative day five; 1.1 [0.9 to 1.6] versus 1.6 [1.4 to 1.9] l (P = 0.001) and 1.6 [1.2 to 2.6] versus 2.3 [1.7 to 2.6] l (P = 0.036), respectively. CONCLUSION Postoperative spirometry is not affected by PEEP and RM during intraoperative ventilation for open abdominal surgery in nonobese patients at a high risk of PPCs, but rather is associated with the development of PPCs. TRIAL REGISTRATION ClinicalTrials.gov NCT01441791.