Protective Ventilation Improves Gas Exchange, Reduces Incidence of Atelectases, and Affects Metabolic Response in Major Pancreatoduodenal Surgery

Vsevolod V Kuzkov; Ludmila N Rodionova; Yana Y Ilyina; Aleksey A Ushakov; Maria M Sokolova; Eugenia V Fot; Boris L Duberman; Mikhail Y Kirov

doi:10.3389/fmed.2016.00066

Protective Ventilation Improves Gas Exchange, Reduces Incidence of Atelectases, and Affects Metabolic Response in Major Pancreatoduodenal Surgery

Front Med (Lausanne). 2016 Dec 6:3:66. doi: 10.3389/fmed.2016.00066. eCollection 2016.

Authors

Vsevolod V Kuzkov¹, Ludmila N Rodionova¹, Yana Y Ilyina¹, Aleksey A Ushakov², Maria M Sokolova¹, Eugenia V Fot¹, Boris L Duberman³, Mikhail Y Kirov¹

Affiliations

¹ Department of Anesthesiology and Intensive Care, Northern State Medical University, Arkhangelsk, Russian Federation; Department of Anesthesiology, City Hospital # 1, Arkhangelsk, Russian Federation.
² Department of Anesthesiology and Intensive Care, Northern State Medical University , Arkhangelsk , Russian Federation.
³ Department of Surgery, Northern State Medical University , Arkhangelsk , Russian Federation.

Abstract

Background: Protective perioperative ventilation has been shown to improve outcomes and reduce the incidence of postoperative pulmonary complications. The goal of this study was to assess the effects of ventilation with low tidal volume (V_T) either alone or in a combination with moderate permissive hypercapnia in major pancreatoduodenal interventions.

Materials and methods: Sixty adult patients scheduled for elective pancreatoduodenal surgery with duration >2 h were enrolled into a prospective single-center study. All patients were randomized to three groups receiving high V_T [10 mL/kg of predicted body weight (PBW), the HVT group, n = 20], low V_T (6 mL/kg PBW, the LVT group, n = 20), and low V_T combined with a moderate hypercapnia and hypercapnic acidosis (6 mL/kg PBW, PaCO₂ 45-60 mm Hg, the LVT + HC group, n = 20). Cardiopulmonary parameters and the incidence of complications were registered during surgery and postoperatively.

Results and discussion: The values of V_T were 610 (563-712), 370 (321-400), and 340 (312-430) mL/kg for the HVT, the LVT, and the LVT + HC groups, respectively (p < 0.001). Compared to the HVT group, PaO₂/FiO₂ ratio was increased in the LVT group by 15%: 333 (301-381) vs. 382 (349-423) mm Hg at 24 h postoperatively (p < 0.05). The HVT group had significantly higher incidence of atelectases (n = 6), despite lower incidence of smoking compared with the LVT (n = 1) group (p = 0.017) and demonstrated longer length of hospital stay. The patients of the LVT + HC group had lower arterial lactate and bicarbonate excess values by the end of surgery.

Conclusion: In major pancreatoduodenal interventions, preventively protective V_T improves postoperative oxygenation, reduces the incidence of atelectases, and shortens length of hospital stay. The combination of low V_T and permissive hypercapnia results in hypercapnic acidosis decreasing the lactate concentration but adding no additional benefits and warrants further investigations.

Keywords: atelectasis; pancreatoduodenal surgery; permissive hypercapnia; postoperative pulmonary complications; protective ventilation.