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Intra-operative open-lung ventilatory strategy reduces postoperative complications after laparoscopic colorectal cancer resection: A randomised controlled trial

BACKGROUND: The role of the positive end-expiratory pressure (PEEP) and lung recruitment manoeuvre (LRM) combination (termed open-lung strategy, OLS) during intra-operative mechanical ventilation is not clear. OBJECTIVE: To determine whether an open-lung strategy constituting medium PEEP (6–8 cmH(2)...

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Detalles Bibliográficos
Autores principales: Li, Hong, Zheng, Zhi-Nan, Zhang, Nan-Rong, Guo, Jing, Wang, Kai, Wang, Wei, Li, Lin-Gui, Jin, Jing, Tang, Jing, Liao, Yao-Jun, Jin, San-Qing
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8452317/
https://www.ncbi.nlm.nih.gov/pubmed/34366425
http://dx.doi.org/10.1097/EJA.0000000000001580
Descripción
Sumario:BACKGROUND: The role of the positive end-expiratory pressure (PEEP) and lung recruitment manoeuvre (LRM) combination (termed open-lung strategy, OLS) during intra-operative mechanical ventilation is not clear. OBJECTIVE: To determine whether an open-lung strategy constituting medium PEEP (6–8 cmH(2)O) and repeated LRMs protects against postoperative complications in at-risk patients undergoing laparoscopic colorectal cancer resection under low-tidal-volume ventilation. DESIGN: A prospective, assessor-blinded, randomised controlled trial. SETTING: Single university-affiliated hospital, conducted from January 2017 to October 2018. PATIENTS: A total of 280 patients at risk of pulmonary complications, scheduled for laparoscopic colorectal cancer resection under general anaesthesia and low-tidal-volume (6–8 ml kg(−1) predicted body weight) ventilation. INTERVENTION: The patients were randomly assigned (1 : 1) to a PEEP of 6–8 cmH(2)O with LRMs repeated every 30 min (OLS group) or a zero PEEP without LRMs (non-OLS group). MAIN OUTCOME MEASURES: The primary outcome was a composite of major pulmonary and extrapulmonary complications occurring within 7 days after surgery. The secondary outcomes included intra-operative potentially harmful hypotension and the need for vasopressors. RESULTS: A total of 130 patients from each group were included in the primary outcome analysis. Primary outcome events occurred in 24 patients (18.5%) in the OLS group and 43 patients (33.1%) in the non-OLS group [relative risk, 0.46; 95% confidence interval (CI), 0.26 to 0.82; P = 0.009). More patients in the OLS group developed potentially harmful hypotension (OLS vs. non-OLS, 15% vs. 4.3%; P = 0.004) and needed vasopressors (25% vs. 8.6%; P < 0.001). CONCLUSION: Among at-risk patients undergoing laparoscopic colorectal cancer resection under low-tidal-volume ventilation, an open-lung strategy with a PEEP of 6–8 cmH(2)O and repeated LRMs reduced postoperative complications compared with a strategy using zero PEEP without LRMs. Of note, LRMs should be used with caution in patients with haemodynamic instability. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT03160144.