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PLoS One. 2017 May 11;12(5):e0177399. doi: 10.1371/journal.pone.0177399. eCollection 2017.

Open lung approach versus standard protective strategies: Effects on driving pressure and ventilatory efficiency during anesthesia - A pilot, randomized controlled trial.

Author information

1
Department of Anesthesiology and Critical Care, Hospital Clínico Universitario, Valencia, Spain.
2
CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
3
Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University Hospital Uppsala, Sweden.
4
Department of Anesthesiology, Hospital Privado de Comunidad, Mar de Plata, Argentina.
5
INCLIVA Clinical Research Institute, Hospital Clínico Universitario, Valencia, Spain.

Abstract

BACKGROUND:

Low tidal volume (VT) during anesthesia minimizes lung injury but may be associated to a decrease in functional lung volume impairing lung mechanics and efficiency. Lung recruitment (RM) can restore lung volume but this may critically depend on the post-RM selected PEEP. This study was a randomized, two parallel arm, open study whose primary outcome was to compare the effects on driving pressure of adding a RM to low-VT ventilation, with or without an individualized post-RM PEEP in patients without known previous lung disease during anesthesia.

METHODS:

Consecutive patients scheduled for major abdominal surgery were submitted to low-VT ventilation (6 ml·kg-1) and standard PEEP of 5 cmH2O (pre-RM, n = 36). After 30 min estabilization all patients received a RM and were randomly allocated to either continue with the same PEEP (RM-5 group, n = 18) or to an individualized open-lung PEEP (OL-PEEP) (Open Lung Approach, OLA group, n = 18) defined as the level resulting in maximal Cdyn during a decremental PEEP trial. We compared the effects on driving pressure and lung efficiency measured by volumetric capnography.

RESULTS:

OL-PEEP was found at 8±2 cmH2O. 36 patients were included in the final analysis. When compared with pre-RM, OLA resulted in a 22% increase in compliance and a 28% decrease in driving pressure when compared to pre-RM. These parameters did not improve in the RM-5. The trend of the DP was significantly different between the OLA and RM-5 groups (p = 0.002). VDalv/VTalv was significantly lower in the OLA group after the RM (p = 0.035).

CONCLUSIONS:

Lung recruitment applied during low-VT ventilation improves driving pressure and lung efficiency only when applied as an open-lung strategy with an individualized PEEP in patients without lung diseases undergoing major abdominal surgery.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT02798133.

PMID:
28493943
PMCID:
PMC5426745
DOI:
10.1371/journal.pone.0177399
[Indexed for MEDLINE]
Free PMC Article

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