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Effects of Intraoperative Ventilation Strategy on Perioperative Atelectasis Assessed by Lung Ultrasonography in Patients Undergoing Open Abdominal Surgery: a Prospective Randomized Controlled Study

Journal of Korean Medical Science 2020년 35권 39호 p.327 ~ 327
조수영, Oh Hye-Won, 최민희, 이현정, 우재희,
소속 상세정보
조수영 ( Cho Soo-Young ) - Ewha Womans University School of Medicine Department of Anesthesiology and Pain Medicine
 ( Oh Hye-Won ) - Ewha Womans University School of Medicine Department of Anesthesiology and Pain Medicine
최민희 ( Choi Min-Hee ) - Ewha Womans University Mokdong Hospital Department of Anesthesiology and Pain Medicine
이현정 ( Lee Hyun-Jung ) - Ewha Womans University School of Medicine Department of Anesthesiology and Pain Medicine
우재희 ( Woo Jae-Hee ) - Ewha Womans University School of Medicine Department of Anesthesiology and Pain Medicine

Abstract


Background: Protective mechanical ventilation using low tidal volume has been introduced to surgical patients to reduce the incidence of postoperative pulmonary complications. We investigated the effects of protective ventilation (PV) techniques on anesthesia-induced atelectasis identified via lung ultrasonography in patients undergoing abdominal surgery.

Methods: A total of 42 adult patients who were scheduled for open abdominal surgery with an expected duration > 2 hours were included in the study. Patients were randomized to receive either conventional ventilation (CV; tidal volume of 9?10 mL/kg predicted body weight [PBW] with no positive end-expiratory pressure [PEEP]) or PV (tidal volume of 6?8 mL/kg PBW and 5 cmH2O PEEP) via pressure-controlled ventilation with volume guaranteed. Lung ultrasonography was performed at four predefined time points to assess perioperative atelectasis by dividing each hemithorax into six quadrants based on a modified lung ultrasound (LUS) scoring system.

Results: The tidal volume delivered to patients was 9.65 ± 1.65 mL/kg PBW in the CV group and 6.31 ± 0.62 mL/kg PBW in the PV group. Ventilation using low tidal volume led to similar LUS scores in all lung areas and at all time points compared to ventilation using high tidal volume. There was no significant difference between the groups in the number of patients requiring recruitment maneuvers at the end of surgery.

Conclusion: Ventilation with low tidal volume combined with 5 cmH2O PEEP did not cause further loss of aeration compared to ventilation with high tidal volume. Low tidal volume ventilation can be used in patients without lung injury based on lung assessment by bedside lung ultrasonography.

키워드

Mechanical Ventilation; Abdominal Surgery; Lung Ultrasonography; Tidal Volume; Atelectasis

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