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Ann Fr Anesth Reanim. 2014 Jul-Aug;33(7-8):472-5. doi: 10.1016/j.annfar.2014.07.007. Epub 2014 Aug 18.

Mechanical ventilation in abdominal surgery.

Author information

1
Department of anesthesiology and critical care medicine, Estaing hospital, university teaching hospital of Clermont-Ferrand, retinoids, reproduction and developmental diseases (R2D2) unit, EA 7281, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France. Electronic address: efutier@chu-clermontferrand.fr.
2
Department of anesthesiology and critical care medicine, Estaing hospital, university teaching hospital of Clermont-Ferrand, retinoids, reproduction and developmental diseases (R2D2) unit, EA 7281, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
3
Department of anaesthesiology and critical care medicine B (DAR B), Saint-Éloi teaching hospital, university hospital of Montpellier, institut national de la santé et de la recherche médicale (Inserm U-1046), 34295 Montpellier, France.

Abstract

One of the key challenges in perioperative care is to reduce postoperative morbidity and mortality. Patients who develop postoperative morbidity but survive to leave hospital have often reduced functional independence and long-term survival. Mechanical ventilation provides a specific example that may help us to shift thinking from treatment to prevention of postoperative complications. Mechanical ventilation in patients undergoing surgery has long been considered only as a modality to ensure gas exchange while allowing maintenance of anesthesia with delivery of inhaled anesthetics. Evidence is accumulating, however, suggesting an association between intraoperative mechanical ventilation strategy and postoperative pulmonary function and clinical outcome in patients undergoing abdominal surgery. Non-protective ventilator settings, especially high tidal volume (VT) (>10-12mL/kg) and the use of very low level of positive end-expiratory pressure (PEEP) (PEEP<5cmH2O) or no PEEP, may cause alveolar overdistension and repetitive tidal recruitment leading to ventilator-associated lung injury in patients with healthy lungs. Stimulated by previous findings in patients with acute respiratory distress syndrome, the use of lower tidal volume ventilation is becoming increasingly more common in the operating room. However, lowering tidal volume, though important, is only part of the overall multifaceted approach of lung protective mechanical ventilation. In this review, we aimed at providing the most recent and relevant clinical evidence regarding the use of mechanical ventilation in patients undergoing abdominal surgery.

KEYWORDS:

Abdominal surgery; Chirurgie abdominale; Complications pulmonaires postopératoires; Mechanical ventilation; Positive end-expiratory pressure; Postoperative pulmonary complications; Pression expiratoire positive; Ventilation mécanique

PMID:
25153670
DOI:
10.1016/j.annfar.2014.07.007
[Indexed for MEDLINE]

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