Perioperative mechanical ventilation for adult non-cardiothoracic surgical patients: a Delphi consensus_West China Medical Journal

Authors：

 Anesthesia Committee of Chengdu Medical Association ,  Chongqing Medical Association Anesthesiology Branch

Corresponding author：

Anesthesia Committee of Chengdu Medical Association, Email: yuhai@scu.edu.cn; Chongqing Medical Association Anesthesiology Branch, Email: lh78553@126.com

Keywords：

Perioperative period; mechanical ventilation; lung injury; pulmonary complications; lung-protective ventilation; expert consensus

DOI：

10.7507/1002-0179.202410028

Video：

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Perioperative mechanical ventilation plays a role in lung injury and postoperative pulmonary complications, yet a consensus in the literature concerning the key clinical question of how to best provide lung protection during mechanical ventilation in surgical patients is lacking. It is necessary to develop an expert consensus on perioperative mechanical ventilation suitable for Chinese anesthesiologists to better guide clinical practice. The experts from the Anesthesia Committee of Chengdu Medical Association and the Chongqing Medical Association Anesthesiology Branch were organized by West China Hospital of Sichuan University to propose the question regarding the perioperative mechanical ventilation, and the current literature was then reviewed, and expert opinions were solicited to provide evidence-based guidance. Subsequently, the expert panel reached a consensus and formulated 28 recommendations with evidence of moderate to high quality using the modified Delphi method.

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2. Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth, 2017, 118(3): 317-334.
3. Mills GH. Respiratory complications of anaesthesia. Anaesthesia, 2018, 73(Suppl 1): 25-33.
4. 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.
5. LAS VEGAS investigators. Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - an observational study in 29 countries. Eur J Anaesthesiol, 2017, 34(8): 492-507.
6. Young CC, Harris EM, Vacchiano C, et al. Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations. Br J Anaesth, 2019, 123(6): 898-913.
7. 饶倩倩, 玉红, 王思洋, 等. 成年人非心胸手术中通气管理的临床实践: 一项全国问卷调查研究. 国际麻醉学与复苏杂志, 2024, 45(2): 168-173.
8. 饶倩倩, 玉红, 余海. 非心胸手术成年患者术中通气管理的临床实践: 一项区域问卷调查研究. 中华麻醉学杂志, 2021, 41(7): 852-857.
9. Atkins D, Eccles M, Flottorp S, et al. Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches The GRADE Working Group. BMC Health Serv Res, 2004, 4(1): 38.
10. Beitler JR, Malhotra A, Thompson BT. Ventilator-induced lung injury. Clin Chest Med, 2016, 37(4): 633-646.
11. Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med, 2013, 369(22): 2126-2136.
12. Sameed M, Choi H, Auron M, et al. Preoperative pulmonary risk assessment. Respir Care, 2021, 66(7): 1150-1166.
13. Qaseem A, Snow V, Fitterman N, et al. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med, 2006, 144(8): 575-580.
14. 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.
15. Junaidi B, Hawrylak A, Kaw R. Evaluation and management of perioperative pulmonary complications. Med Clin North Am, 2024, 108(6): 1087-1100.
16. Lane S, Saunders D, Schofield A, et al. A prospective, randomised controlled trial comparing the efficacy of pre-oxygenation in the 20 degrees head-up vs supine position. Anaesthesia, 2005, 60(11): 1064-1067.
17. Ramkumar V, Umesh G, Philip FA. Preoxygenation with 20º head-up tilt provides longer duration of non-hypoxic apnea than conventional preoxygenation in non-obese healthy adults. J Anesth, 2011, 25(2): 189-194.
18. Couture EJ, Provencher S, Somma J, et al. Effect of position and positive pressure ventilation on functional residual capacity in morbidly obese patients: a randomized trial. Can J Anaesth, 2018, 65(5): 522-528.
19. Nimmagadda U, Salem MR, Crystal GJ. Preoxygenation: physiologic basis, benefits, and potential risks. Anesth Analg, 2017, 124(2): 507-517.
20. Mathew G, Manjuladevi M, Joachim N, et al. Effect of high fresh gas flow and pattern of breathing on rapid preoxygenation. Indian J Anaesth, 2022, 66(3): 213-219.
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