Effects of lung protective ventilation on postoperative pulmonary outcomes for prolonged oral cancer combined with free flap surgery

The intraoperative lung protective ventilation with low tidal volume, positive end expiratory pressure (PEEP) and intermittent lungs recruitment was found to decrease postoperative pulmonary complications. In this retrospective medical records study, we investigated the effects of lung protective ventilation on postoperative pulmonary outcomes among the patients received prolonged oral cancer combined with free flap surgery. We collected the medical records of the patients received oral cancer surgery with the operation time more than 12 hours from January 2011 to December 2015. We recorded 1. the patients’ characteristics, past medical history, and laboratory data; 2. intraoperative peak airway pressure, fluid intake, urine output, blood loss, and operation duration; 3. postoperative PaO(2)/FiO(2) (P/F) ratio when arrived at intensive care unit (ICU), infiltration on Chest X-ray (CXR), duration of ventilator use, ICU stay and hospital stay. Fifty nine cases were included. Thirty cases received the lung protective ventilation and 29 cases received conventional ventilation. Compared to the patients received conventional ventilation, the patients received intraoperative lung protective ventilation showed 1. higher postoperative P/F ratio (556.6 ± 115.2) vs 341.9 ± 72.7, P < .001); 2. lower incidence of infiltration on postoperative CXR (23.3% vs 51.7%, P = .047); 3. shorter duration of ventilator use (6.2 ± 4.5 vs 12.8 ± 7.5 days, P < .001); and 4. shorter duration of ICU stay (9.4 ± 5.3 vs 17.1 ± 8.3 days, P < .001). In conclusion, for the prolonged oral cancer combined with free flap surgery, the intraoperative lung protective ventilation improves postoperative pulmonary outcomes and decreases the duration of ICU stay.