Impact analysis of ventilation mode on pulmonary complications after laparoscopic weight loss surgery for patients with obese_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YE Qianlin , HU Haoxiang , XU Jinxiong , TU Zehua , LU Zengting

Department of Anesthesiology, Xiaolan People’s Hospital of Zhongshan, Zhongshan, Guangdong 528415, P. R. China;

Corresponding author：

YE Qianlin, Email: shexi5954@163.com

Keywords：

pressure-controlled ventilation-volume guaranteed; volume-controlled ventilation; laparoscopic weight loss surgery; obesity; postoperative pulmonary complication

DOI：

10.7507/1007-9424.202402015

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To explore the effect of different ventilation modes on pulmonary complications (PCs) after laparoscopic weight loss surgery in obese patients. Methods The obese patients who underwent laparoscopic weight loss surgery in the Xiaolan People’s Hospital of Zhongshan from January 2019 to June 2023 were retrospectively collected, then were assigned into pressure-controlled ventilation-volume guaranteed (PCV-VG) group and volume controlled ventilation (VCV) group according to the different ventilation modes during anesthesia. The clinicopathologic data of the patients between the PCV-VG group and VCV group were compared. The occurrence of postoperative PCs was understood and the risk factors affecting the postoperative PCs for the obese patients underwent laparoscopic weight loss surgery were analyzed by multivariate logistic regression analysis. Results A total of 294 obese patients who underwent laparoscopic weight loss surgery were enrolled, with 138 males and 156 females; Body mass index (BMI) was 30–55 kg/m², (42.40±4.87) kg/m². The postoperative PCs occurred in 63 cases (21.4%). There were 160 cases in the PCV-VG group and 134 cases in the VCV group. The anesthesia time, tidal volume at 5 min after tracheal intubation, peak inspiratory pressure and driving pressure at 5 min after tracheal intubation, 60 min after establishing pneumoperitoneum, and the end of surgery, as well as incidence of postoperative PCs in the PCV-VG group were all less or lower than those in the VCV group (P<0.05). The indicators with statistical significance by univariate analysis in combination with significant clinical indicators were enrolled in the multivariate logistic regression model, such as the smoking history, American Society of Anesthesiologists classification, hypertension, BMI, operation time, forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity, and intraoperative ventilation mode. It was found that the factors had no collinearity (tolerance>0.1, and variance inflation factor<10). The results of the multivariate logistic regression analysis showed that the patients with higher BMI and intraoperative VCV mode increased the probability of postoperative PCs (P<0.05). Conclusions From the preliminary results of this study, for the obese patients underwent laparoscopic weight loss surgery, the choice of ventilation mode is closely related to the risk of developing postoperative PCs. In clinical practice, it is particularly important to pay attention to the risk of postoperative PCs for the patients with higher degree obesity.

Citation： YE Qianlin, HU Haoxiang, XU Jinxiong, TU Zehua, LU Zengting. Impact analysis of ventilation mode on pulmonary complications after laparoscopic weight loss surgery for patients with obese. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(8): 976-980. doi: 10.7507/1007-9424.202402015 Copy

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2.	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.
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4.	Zorrilla-Vaca A, Grant MC, Rehman M, et al. Postoperative hypoxemia after dual-controlled vs volume-controlled ventilation in lung surgery. Ann Thorac Surg, 2023, 116(1): 173-179.
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7.	中华医学会内分泌学分会肥胖学组. 中国成人肥胖症防治专家共识. 中华内分泌代谢杂志, 2011, 27(9): 711-717.
8.	Sundaram K, Mu J, Kumar A, et al. Garlic exosome-like nanoparticles reverse high-fat diet induced obesity via the gut/brain axis. Theranostics, 2022, 12(3): 1220-1246.
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11.	Grönroos S, Helmiö M, Juuti A, et al. Effect of laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass on weight loss and quality of life at 7 years in patients with morbid obesity: the SLEEVEPASS randomized clinical trial. JAMA Surg, 2021, 156(2): 137-146.
12.	李建忠, 吴建强, 王正峰. 腹腔镜袖状胃切除术治疗肥胖及其并发症20例报告. 腹腔镜外科杂志, 2023, 28(4): 247-250.
13.	Jogiat U, Mocanu V, Birch DW, et al. Pulmonary complications are a strong independent predictor of 30-day mortality following elective bariatric surgery. Obes Surg, 2022, 32(3): 696-703.
14.	刘倩, 郑旭, 夏天娇, 等. 减重手术患者术后肺部并发症的预防策略. 中华麻醉学杂志, 2021, 41(1): 12-15.
15.	宋子晨. 肺保护性通气策略对机器人减重手术患者氧合功能及呼吸力学的影响. 长春: 吉林大学, 2021.
16.	Huang D, Zhou S, Yu Z, et al. Lung protective ventilation strategy to reduce postoperative pulmonary complications (PPCs) in patients undergoing robot-assisted laparoscopic radical cystectomy for bladder cancer: a randomized double blinded clinical trial. J Clin Anesth, 2021, 71: 110156. doi: 10.1016/j.jclinane.2020.110156.
17.	Wang P, Zhao S, Gao Z, et al. Use of volume controlled vs. pressure controlled volume guaranteed ventilation in elderly patients undergoing laparoscopic surgery with laryngeal mask airway. BMC Anesthesiol, 2021, 21(1): 69. doi: 10.1186/s12871-021-01292-y.
18.	郝立迎. 不同通气模式下的肺保护通气策略对老年患者腹腔镜胃癌手术呼吸力学及术后肺部并发症的影响. 石家庄: 河北医科大学, 2020.
19.	王朋飞, 代伟娜, 刘礼新, 等. 高体质量指数对胸腔镜下肺癌根治术围术期并发症及临床疗效的影响. 肿瘤研究与临床, 2019, 31(3): 167-171.

1. Pan XF, Wang L, Pan A. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol, 2021, 9(6): 373-392.
2. 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.
3. Douville NJ, McMurry TL, Ma JZ, et al. Airway driving pressure is associated with postoperative pulmonary complications after major abdominal surgery: a multicentre retrospective observational cohort study. BJA Open, 2022, 4: 100099. doi: 10.1016/j.bjao.2022.100099.
4. Zorrilla-Vaca A, Grant MC, Rehman M, et al. Postoperative hypoxemia after dual-controlled vs volume-controlled ventilation in lung surgery. Ann Thorac Surg, 2023, 116(1): 173-179.
5. Li J, Ma S, Chang X, et al. Effect of pressure-controlled ventilation-volume guaranteed mode combined with individualized positive end-expiratory pressure on respiratory mechanics, oxygenation and lung injury in patients undergoing laparoscopic surgery in Trendelenburg position. J Clin Monit Comput, 2022, 36(4): 1155-1164.
6. Yılmaz H, Kazbek BK, Köksoy ÜC, et al. Hemodynamic outcome of different ventilation modes in laparoscopic surgery with exaggerated trendelenburg: a randomised controlled trial. Braz J Anesthesiol, 2022, 72(1): 88-94.
7. 中华医学会内分泌学分会肥胖学组. 中国成人肥胖症防治专家共识. 中华内分泌代谢杂志, 2011, 27(9): 711-717.
8. Sundaram K, Mu J, Kumar A, et al. Garlic exosome-like nanoparticles reverse high-fat diet induced obesity via the gut/brain axis. Theranostics, 2022, 12(3): 1220-1246.
9. Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation, 2021, 143(21): e984-e1010. doi: 10.1161/CIR.0000000000000973.
10. 刘晶, 韩建立, 郭晨浩. 腹腔镜袖状胃切除术对肥胖症合并高血压的疗效分析. 腹腔镜外科杂志, 2023, 28(4): 241-246.
11. Grönroos S, Helmiö M, Juuti A, et al. Effect of laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass on weight loss and quality of life at 7 years in patients with morbid obesity: the SLEEVEPASS randomized clinical trial. JAMA Surg, 2021, 156(2): 137-146.
12. 李建忠, 吴建强, 王正峰. 腹腔镜袖状胃切除术治疗肥胖及其并发症20例报告. 腹腔镜外科杂志, 2023, 28(4): 247-250.
13. Jogiat U, Mocanu V, Birch DW, et al. Pulmonary complications are a strong independent predictor of 30-day mortality following elective bariatric surgery. Obes Surg, 2022, 32(3): 696-703.
14. 刘倩, 郑旭, 夏天娇, 等. 减重手术患者术后肺部并发症的预防策略. 中华麻醉学杂志, 2021, 41(1): 12-15.
15. 宋子晨. 肺保护性通气策略对机器人减重手术患者氧合功能及呼吸力学的影响. 长春: 吉林大学, 2021.
16. Huang D, Zhou S, Yu Z, et al. Lung protective ventilation strategy to reduce postoperative pulmonary complications (PPCs) in patients undergoing robot-assisted laparoscopic radical cystectomy for bladder cancer: a randomized double blinded clinical trial. J Clin Anesth, 2021, 71: 110156. doi: 10.1016/j.jclinane.2020.110156.
17. Wang P, Zhao S, Gao Z, et al. Use of volume controlled vs. pressure controlled volume guaranteed ventilation in elderly patients undergoing laparoscopic surgery with laryngeal mask airway. BMC Anesthesiol, 2021, 21(1): 69. doi: 10.1186/s12871-021-01292-y.
18. 郝立迎. 不同通气模式下的肺保护通气策略对老年患者腹腔镜胃癌手术呼吸力学及术后肺部并发症的影响. 石家庄: 河北医科大学, 2020.
19. 王朋飞, 代伟娜, 刘礼新, 等. 高体质量指数对胸腔镜下肺癌根治术围术期并发症及临床疗效的影响. 肿瘤研究与临床, 2019, 31(3): 167-171.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Impact analysis of ventilation mode on pulmonary complications after laparoscopic weight loss surgery for patients with obese

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