Individualized lung protective ventilation vs. conventional ventilation during general anesthesia in laparoscopic total hysterectomy

Jing Liu; Xinhua Huang; Siping Hu; Zhipeng Meng; Huanzhong He

doi:10.3892/etm.2020.8549

Individualized lung protective ventilation vs. conventional ventilation during general anesthesia in laparoscopic total hysterectomy

Exp Ther Med. 2020 Apr;19(4):3051-3059. doi: 10.3892/etm.2020.8549. Epub 2020 Feb 25.

Authors

Jing Liu¹, Xinhua Huang¹, Siping Hu², Zhipeng Meng², Huanzhong He²

Affiliations

¹ Department of Anesthesiology, Huzhou Maternity and Child Healthcare Hospital, Huzhou, Zhejiang 313000, P.R. China.
² Department of Anesthesiology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, Zhejiang 313000, P.R. China.

Abstract

Laparoscopic total hysterectomy is performed by carbon dioxide insufflation, Trendelenburg position and mechanical ventilation of patients under general anesthesia. However, this may induce pulmonary atelectasis and/or hyperdistention of the lungs. Multiple studies have indicated that mechanical ventilation with the use of low tidal volumes, moderate positive end-expiratory pressure (PEEP) and regular alveolar recruitment maneuvers may improve post-operative outcomes. However, the benefits of an individualized level of PEEP have not been clearly established. In the present study, it was hypothesized that a moderate fixed PEEP may not suit all patients and an individually-titrated PEEP during anesthesia may improve the peri-operative pulmonary oxygenation function. The aim of the present study was to compare the pulmonary oxygenation function and post-operative pulmonary complications (PPCs) in patients receiving individualized lung-protective mechanical ventilation (LPV) vs. conventional ventilation (CV) during laparoscopic total hysterectomy. The present study was a randomized double-blinded clinical trial on 87 patients who were randomly divided to receive CV or protective ventilation (PV). An optimal individualized PEEP value was determined using a static pulmonary compliance-directed PEEP titration procedure. Pulmonary oxygenation function, serum inflammatory factors, including interleukin-8 and Clara cell protein 16, the incidence of PPCs and the post-operative length of stay were also determined. Patients in the PV group exhibited improved pulmonary oxygenation function during and after the operation. The total percentage of PPCs during the first 7 days after surgery was significantly lower in the PV group compared with those in the CV group. In conclusion, as compared to CV, intra-operative individualized LPV significantly improved pulmonary oxygenation function and reduced the incidence of PPCs during the first 7 days after laparoscopic total hysterectomy (Clinical trial registration no. ChiCTR1900027738).

Keywords: individualized positive end-expiratory pressure; laparoscopic total hysterectomy; lung-protective mechanical ventilation; post-operative pulmonary complications; pulmonary oxygenation function.