Effect of different ventilation modes on postoperative pulmonary complications in elderly patients undergoing abdominal surgery in lung protective ventilation strategy: a prospective, randomized, controlled study_West China Medical Journal

Authors：

YU Xia ¹ ,  ZHU Chan ² , TANG Dong ² , XIA Zongjing ² , ZHAO Lina ²

1. Department of Anesthesiology, Chengfei Hospital, Chengdu, Sichuan 610073, P. R. China;
2. Department of Anesthesiology, Chengdu Office Hospital of the People’s Government of Tibet Autonomous Region, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZHU Chan, Email: 272960926@qq.com

Keywords：

Ventilation modes; postoperative pulmonary complications; elderly patients; lung protective ventilation

DOI：

10.7507/1002-0179.202301100

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the effects of different ventilation modes on postoperative pulmonary complications in elderly patients undergoing abdominal surgery. Methods The patients who underwent upper abdominal surgery under general anesthesia in Chengdu Office Hospital of the People’s Government of Tibet Autonomous Region between February 2020 and February 2021 were selected. Patients were randomly divided into volume controlled ventilation (VCV) group, pressure controlled ventilation (PCV) group, and pressure controlled ventilation-volume guarantee (PCV-VG) group according to the random number table method. All the three groups adopted the internationally recognized lung protective ventilation strategy. The transcutaneous arterial oxygen saturation and respiratory mechanics indicators of three different time periods, as well as pulmonary symptoms and signs and laboratory imaging examinations 7 days after surgery were recorded. The incidence of postoperative pulmonary complications in the three groups of patients were evaluated using the Melbourne Group Scale Version 2. Results A total of 120 patients were included, with 40 in each group. There was no statistically significant difference in the general situation of the three groups of patients (P>0.05). The platform pressure and compliance of three different time periods all changed over time (P<0.05). There were statistically significant differences in the occurrence of pulmonary complications and hospital stay among the three groups 7 days after surgery (P<0.05). Conclusion Under the internationally recognized lung protective ventilation strategy, PCV-VG mode can significantly reduce the incidence of pulmonary complications 7 days after abdominal surgery, shorten the length of hospital stay, and improve the quality of life in elderly patients.

Citation： YU Xia, ZHU Chan, TANG Dong, XIA Zongjing, ZHAO Lina. Effect of different ventilation modes on postoperative pulmonary complications in elderly patients undergoing abdominal surgery in lung protective ventilation strategy: a prospective, randomized, controlled study. West China Medical Journal, 2023, 38(8): 1167-1173. doi: 10.7507/1002-0179.202301100 Copy

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2.	Fernandez-Bustamante A, Frendl G, Sprung J, et al. Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: a multicenter study by the perioperative research network investigators. JAMA Surg, 2017, 152(2): 157-166.
3.	Fisher BW, Majumdar SR, McAlister FA. Predicting pulmonary complications after nonthoracic surgery: a systematic review of blinded studies. Am J Med, 2002, 112(3): 219-225.
4.	Langeron O, Carreira S, le Saché F, et al. Postoperative pulmonary complications updating. Ann Fr Anesth Reanim, 2014, 33(7/8): 480-483.
5.	Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology, 2010, 113(6): 1338-1350.
6.	曾清. 重症监护室的院内肺部真菌感染临床研究. 中华医院感染学杂志, 2002, 12(7): 488-490.
7.	Kanat F, Golcuk A, Teke T, et al. Risk factors for postoperative pulmonary complications in upper abdominal surgery. ANZ J Surg, 2007, 77(3): 135-141.
8.	Li X, Chen C, Wei X, et al. Retrospective comparative study on postoperative pulmonary complications after orthotopic liver transplantation using the melbourne group scale (MGS-2) diagnostic criteria. Ann Transplant, 2018, 23: 377-386.
9.	Tao T, Bo L, Chen F, et al. Effect of protective ventilation on postoperative pulmonary complications in patients undergoing general anaesthesia: a meta-analysis of randomised controlled trials. BMJ Open, 2014, 4(6): e005208.
10.	Ladha K, Vidal Melo MF, McLean DJ, et al. Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications: hospital based registry study. BMJ, 2015, 351: h3646.
11.	Gu WJ, Wang F, Liu JC. Effect of lung-protective ventilation with lower tidal volumes on clinical outcomes among patients undergoing surgery: a meta-analysis of randomized controlled trials. CMAJ, 2015, 187(3): E101-E109.
12.	Yang D, Grant MC, Stone A, et al. A meta-analysis of intraoperative ventilation strategies to prevent pulmonary complications: is low tidal volume alone sufficient to protect healthy lungs?. Ann Surg, 2016, 263(5): 881-887.
13.	Güldner A, Kiss T, Serpa Neto A, et al. Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers. Anesthesiology, 2015, 123(3): 692-713.
14.	Serpa Neto A, Hemmes SN, Barbas CS, et al. Protective versus conventional ventilation for surgery: a systematic review and individual patient data meta-analysis. Anesthesiology, 2015, 123(1): 66-78.
15.	Ferrando C, Soro M, Unzueta C, et al. Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial. Lancet Respir Med, 2018, 6(3): 193-203.
16.	Alam N, Park BJ, Wilton A, et al. Incidence and risk factors for lung injury after lung cancer resection. Ann Thorac Surg, 2007, 84(4): 1085-1091; discussion 1091.
17.	Licker M, de Perrot M, Spiliopoulos A, et al. Risk factors for acute lung injury after thoracic surgery for lung cancer. Anesth Analg, 2003, 97(6): 1558-1565.
18.	Jiang J, Li B, Kang N, et al. Pressure-controlled versus volume-controlled ventilation for surgical patients: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth, 2016, 30(2): 501-514.
19.	Kothari A, Baskaran D. Pressure-controlled volume guaranteed mode improves respiratory dynamics during laparoscopic cholecystectomy: a comparison with conventional modes. Anesth Essays Res, 2018, 12(1): 206-212.
20.	Moningi S, Elmati PK, Rao P, et al. Comparison of volume control and pressure control ventilation in patients undergoing single level anterior cervical discectomy and fusion surgery. Indian J Anaesth, 2017, 61(10): 818-825.
21.	Movassagi R, Montazer M, Mahmoodpoor A, et al. Comparison of pressure vs. volume controlled ventilation on oxygenation parameters of obese patients undergoing laparoscopic cholecystectomy. Pak J Med Sci, 2017, 33(5): 1117-1122.
22.	Kim YS, Won YJ, Lee DK, et al. Lung ultrasound score-based perioperative assessment of pressure-controlled ventilation-volume guaranteed or volume-controlled ventilation in geriatrics: a prospective randomized controlled trial. Clin Interv Aging, 2019, 14: 1319-1329.
23.	Kim KN, Kim DW, Jeong MA, et al. Comparison of pressure-controlled ventilation with volume-controlled ventilation during one-lung ventilation: a systematic review and meta-analysis. BMC Anesthesiol, 2016, 16(1): 72.
24.	Dion JM, McKee C, Tobias JD, et al. Ventilation during laparoscopic-assisted bariatric surgery: volume-controlled, pressure-controlled or volume-guaranteed pressure-regulated modes. Int J Clin Exp Med, 2014, 7(8): 2242-2247.
25.	Pu J, Liu Z, Yang L, et al. Applications of pressure control ventilation volume guaranteed during one-lung ventilation in thoracic surgery. Int J Clin Exp Med, 2014, 7(4): 1094-1098.
26.	Song SY, Jung JY, Cho MS, et al. Volume-controlled versus pressure-controlled ventilation-volume guaranteed mode during one-lung ventilation. Korean J Anesthesiol, 2014, 67(4): 258-263.
27.	Liu Z, Liu X, Huang Y, et al. Intraoperative mechanical ventilation strategies in patients undergoing one-lung ventilation: a meta-analysis. Springerplus, 2016, 5(1): 1251.

1. Roscio F, Bertoglio C, De Luca A, et al. Outcomes of laparoscopic surgery for colorectal cancer in elderly patients. JSLS, 2011, 15(3): 315-321.
2. Fernandez-Bustamante A, Frendl G, Sprung J, et al. Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: a multicenter study by the perioperative research network investigators. JAMA Surg, 2017, 152(2): 157-166.
3. Fisher BW, Majumdar SR, McAlister FA. Predicting pulmonary complications after nonthoracic surgery: a systematic review of blinded studies. Am J Med, 2002, 112(3): 219-225.
4. Langeron O, Carreira S, le Saché F, et al. Postoperative pulmonary complications updating. Ann Fr Anesth Reanim, 2014, 33(7/8): 480-483.
5. Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology, 2010, 113(6): 1338-1350.
6. 曾清. 重症监护室的院内肺部真菌感染临床研究. 中华医院感染学杂志, 2002, 12(7): 488-490.
7. Kanat F, Golcuk A, Teke T, et al. Risk factors for postoperative pulmonary complications in upper abdominal surgery. ANZ J Surg, 2007, 77(3): 135-141.
8. Li X, Chen C, Wei X, et al. Retrospective comparative study on postoperative pulmonary complications after orthotopic liver transplantation using the melbourne group scale (MGS-2) diagnostic criteria. Ann Transplant, 2018, 23: 377-386.
9. Tao T, Bo L, Chen F, et al. Effect of protective ventilation on postoperative pulmonary complications in patients undergoing general anaesthesia: a meta-analysis of randomised controlled trials. BMJ Open, 2014, 4(6): e005208.
10. Ladha K, Vidal Melo MF, McLean DJ, et al. Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications: hospital based registry study. BMJ, 2015, 351: h3646.
11. Gu WJ, Wang F, Liu JC. Effect of lung-protective ventilation with lower tidal volumes on clinical outcomes among patients undergoing surgery: a meta-analysis of randomized controlled trials. CMAJ, 2015, 187(3): E101-E109.
12. Yang D, Grant MC, Stone A, et al. A meta-analysis of intraoperative ventilation strategies to prevent pulmonary complications: is low tidal volume alone sufficient to protect healthy lungs?. Ann Surg, 2016, 263(5): 881-887.
13. Güldner A, Kiss T, Serpa Neto A, et al. Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers. Anesthesiology, 2015, 123(3): 692-713.
14. Serpa Neto A, Hemmes SN, Barbas CS, et al. Protective versus conventional ventilation for surgery: a systematic review and individual patient data meta-analysis. Anesthesiology, 2015, 123(1): 66-78.
15. Ferrando C, Soro M, Unzueta C, et al. Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial. Lancet Respir Med, 2018, 6(3): 193-203.
16. Alam N, Park BJ, Wilton A, et al. Incidence and risk factors for lung injury after lung cancer resection. Ann Thorac Surg, 2007, 84(4): 1085-1091; discussion 1091.
17. Licker M, de Perrot M, Spiliopoulos A, et al. Risk factors for acute lung injury after thoracic surgery for lung cancer. Anesth Analg, 2003, 97(6): 1558-1565.
18. Jiang J, Li B, Kang N, et al. Pressure-controlled versus volume-controlled ventilation for surgical patients: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth, 2016, 30(2): 501-514.
19. Kothari A, Baskaran D. Pressure-controlled volume guaranteed mode improves respiratory dynamics during laparoscopic cholecystectomy: a comparison with conventional modes. Anesth Essays Res, 2018, 12(1): 206-212.
20. Moningi S, Elmati PK, Rao P, et al. Comparison of volume control and pressure control ventilation in patients undergoing single level anterior cervical discectomy and fusion surgery. Indian J Anaesth, 2017, 61(10): 818-825.
21. Movassagi R, Montazer M, Mahmoodpoor A, et al. Comparison of pressure vs. volume controlled ventilation on oxygenation parameters of obese patients undergoing laparoscopic cholecystectomy. Pak J Med Sci, 2017, 33(5): 1117-1122.
22. Kim YS, Won YJ, Lee DK, et al. Lung ultrasound score-based perioperative assessment of pressure-controlled ventilation-volume guaranteed or volume-controlled ventilation in geriatrics: a prospective randomized controlled trial. Clin Interv Aging, 2019, 14: 1319-1329.
23. Kim KN, Kim DW, Jeong MA, et al. Comparison of pressure-controlled ventilation with volume-controlled ventilation during one-lung ventilation: a systematic review and meta-analysis. BMC Anesthesiol, 2016, 16(1): 72.
24. Dion JM, McKee C, Tobias JD, et al. Ventilation during laparoscopic-assisted bariatric surgery: volume-controlled, pressure-controlled or volume-guaranteed pressure-regulated modes. Int J Clin Exp Med, 2014, 7(8): 2242-2247.
25. Pu J, Liu Z, Yang L, et al. Applications of pressure control ventilation volume guaranteed during one-lung ventilation in thoracic surgery. Int J Clin Exp Med, 2014, 7(4): 1094-1098.
26. Song SY, Jung JY, Cho MS, et al. Volume-controlled versus pressure-controlled ventilation-volume guaranteed mode during one-lung ventilation. Korean J Anesthesiol, 2014, 67(4): 258-263.
27. Liu Z, Liu X, Huang Y, et al. Intraoperative mechanical ventilation strategies in patients undergoing one-lung ventilation: a meta-analysis. Springerplus, 2016, 5(1): 1251.

West China Medical Journal

Effect of different ventilation modes on postoperative pulmonary complications in elderly patients undergoing abdominal surgery in lung protective ventilation strategy: a prospective, randomized, controlled study

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