Effects of an Alveolar Recruitment Maneuver During Lung Protective Ventilation on Postoperative Pulmonary Complications in Elderly Patients Undergoing Laparoscopy
Open Access
- 1 August 2020
- journal article
- research article
- Published by Taylor & Francis Ltd in Clinical Interventions in Aging
- Vol. ume 15, 1461-1469
- https://doi.org/10.2147/cia.s264987
Abstract
Purpose: Controversy remains over whether alveolar recruitment maneuvers (ARMs) can reduce postoperative pulmonary complications. We hypothesized that performing an ARM in addition to lung protective ventilation (LPV) could improve intraoperative arterial oxygenation and postoperative pulmonary complications (PPCs) in elderly patients undergoing laparoscopy in the Trendelenburg position. Patients and Methods: Sixty-two patients (aged 65– 85) scheduled for laparoscopic low anterior resection were randomized to receive LPV only (LPV group, n = 32) or LPV with an ARM (ARM group, n = 30). LPV was set to a tidal volume of 6 mL/kg with a positive end expiratory pressure (PEEP) of 5 cmH2O. The ARM was performed by serially increasing the PEEP to 10 cmH2O for 3 breaths, 15 cmH2O for 3 breaths, then 20 cmH2O for 10 breaths, both immediately before and after abdominal insufflation. The primary end-point was the frequency of PPCs such as desaturation (SpO2 < 90%), atelectasis, and pneumonia. Secondary end-points were changes in intraoperative respiratory and gas exchange parameters and hemodynamic variables. Results: One patient in the LPV group experienced desaturation on the first postoperative day. The frequency of chest X-ray abnormalities such as atelectasis or pleural effusion was comparable between groups (6 (19%) and 5 (17%) patients, respectively, P = 0.676). Changes in other respiratory, gas exchange and hemodynamic parameters over time were not significantly different between the groups. However, vasopressor requirements during surgery were higher in the ARM than the LPV group (9 (30%) and 2 (6%) patients, respectively, P = 0.014). Conclusion: This study suggests that performing an ARM during LPV may not improve postoperative respiratory outcomes and intraoperative oxygenation compared to LPV alone in geriatric patients undergoing laparoscopy in the Trendelenburg position. In addition, since the ARM could cause a significant deterioration in hemodynamic parameters, applying ARM to elderly patients should be carefully considered.Keywords
This publication has 36 references indexed in Scilit:
- Postoperative pulmonary complications, pulmonary and systemic inflammatory responses after lung resection surgery with prolonged one-lung ventilation. Randomized controlled trial comparing intravenous and inhalational anaesthesiaBritish Journal of Anaesthesia, 2017
- Effects of recruitment manoeuvre on perioperative pulmonary complications in patients undergoing robotic assisted radical prostatectomy: A randomised single-blinded trialPLOS ONE, 2017
- The Effect of Equal Ratio Ventilation on Oxygenation, Respiratory Mechanics, and Cerebral Perfusion Pressure During Laparoscopy in the Trendelenburg PositionSurgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2016
- The effects of intraoperative lung protective ventilation with positive end-expiratory pressure on blood loss during hepatic resection surgeryEuropean Journal of Anaesthesiology, 2016
- Clinical and economic burden of postoperative pulmonary complications: Patient safety summit on definition, risk-reducing interventions, and preventive strategies*Critical Care Medicine, 2011
- Prediction of Postoperative Pulmonary Complications in a Population-based Surgical CohortAnesthesiology, 2010
- Prevention of Atelectasis in Morbidly Obese Patients during General Anesthesia and ParalysisAnesthesiology, 2009
- [Pulmonary function in aging].2009
- Influence of Age on Surfactant Isolated from Healthy Horses Maintained on PastureJournal of Veterinary Internal Medicine, 2009
- Review article: Age related alterations in respiratory function — anesthetic considerationsCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 2006