Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations
Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations
复制标题
DOI：
10.1016/j.bja.2019.08.017
复制
发表时间：
2019-12-01
影响因子：
9.8
通讯作者：
Sprung, Juraj
中科院分区：
文献类型：
--
作者：
Young, Christopher C.;Harris, Erica M.;Sprung, Juraj
术后肺部并发症（PPCs）经常发生，并与大量的发病率和死亡率相关。有证据表明，术中使用肺保护性通气策略可以降低PPCs，但围手术期管理尚未达成共识。我们试图在一次国际共识发展会议上确定外科患者肺保护的建议。7位专家提出了24个问题，涉及有发生PPCs风险患者的术前评估和术中机械通气。六名研究人员用问题作为他们回顾的框架来评估文献。一组专家利用改进的德尔菲法从研究问题中提出建议和陈述。专家就22项建议和4项声明达成了协商一致意见。以下是重点：(i)术前肺风险评估应使用专用评分；（ii）个体化机械通气可改善呼吸机制和呼吸功能，并预防PPCs。呼吸机的初始潮气量应设定为6-8 ml kg（-1）预测体重和呼气末正压（PEEP） 5 cm H2O。此后应个体化PEEP。当进行吸气时，应使用最低的有效压力和最短的有效时间或最少的呼吸次数。
Postoperative pulmonary complications (PPCs) occur frequently and are associated with substantial morbidity and mortality. Evidence suggests that reduction of PPCs can be accomplished by using lung-protective ventilation strategies intraoperatively, but a consensus on perioperative management has not been established. We sought to determine recommendations for lung protection for the surgical patient at an international consensus development conference. Seven experts produced 24 questions concerning preoperative assessment and intraoperative mechanical ventilation for patients at risk of developing PPCs. Six researchers assessed the literature using questions as a framework for their review. The modified Delphi method was utilised by a team of experts to produce recommendations and statements from study questions. An expert consensus was reached for 22 recommendations and four statements. The following are the highlights: (i) a dedicated score should be used for preoperative pulmonary risk evaluation; and (ii) an individualised mechanical ventilation may improve the mechanics of breathing and respiratory function, and prevent PPCs. The ventilator should initially be set to a tidal volume of 6-8 ml kg(-1) predicted body weight and positive end-expiratory pressure (PEEP) 5 cm H2O. PEEP should be individualised thereafter. When recruitment manoeuvres are performed, the lowest effective pressure and shortest effective time or fewest number of breaths should be used.