Ventilation with high versus low peep levels during general anaesthesia for open abdominal surgery does not affect postoperative spirometry: A randomised clinical trial.

Abstract

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.

• Authors: Tanja A Treschan, Maximilian Schaefer, Johann Kemper, Bea Bastin, Peter Kienbaum, Benedikt Pannen, Sabrine N Hemmes, Marcelo G de Abreu, Paolo Pelosi, Marcus J Schultz, PROVE Network Investigators
• Journal: European journal of anaesthesiology (Eur J Anaesthesiol) Vol. 34 Issue 8 Pg. 534-543 (08 2017) ISSN: 1365-2346 [Electronic] England
• PMID: 28306591 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Abdomen (surgery)
• Adult
• Aged
• Anesthesia, General (adverse effects, methods)
• Female
• Humans
• Internationality
• Intraoperative Care (adverse effects, methods)
• Male
• Middle Aged
• Positive-Pressure Respiration (adverse effects, methods)
• Postoperative Complications (diagnosis, epidemiology, physiopathology)
• Respiration, Artificial (adverse effects, methods)
• Spirometry (adverse effects, methods)
• Tidal Volume (physiology)