Effects of an Alveolar Recruitment Maneuver During Lung Protective Ventilation on Postoperative Pulmonary Complications in Elderly Patients Undergoing Laparoscopy

Youn Yi Jo, Kyung Cheon Lee, Young Jin Chang, Wol Seon Jung, Jongchul Park, Hyun Jeong Kwak Department of Anesthesiology and Pain Medicine, Gachon University College of Medicine, Gil Hospital, Incheon, Republic of KoreaCorrespondence: Hyun Jeong Kwak Email hyun615@gilhospital.comPurpose: Controversy...

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Autores principales:	Jo YY, Lee KC, Chang YJ, Jung WS, Park J, Kwak HJ
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	alveolar recruitment maneuver geriatric lung protective ventilation pneumoperitoneum Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/848742fe19794fb7a4acb2a4ff47c4bb
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spelling	oai:doaj.org-article:848742fe19794fb7a4acb2a4ff47c4bb2021-12-02T10:26:13ZEffects of an Alveolar Recruitment Maneuver During Lung Protective Ventilation on Postoperative Pulmonary Complications in Elderly Patients Undergoing Laparoscopy1178-1998https://doaj.org/article/848742fe19794fb7a4acb2a4ff47c4bb2020-08-01T00:00:00Zhttps://www.dovepress.com/effects-of-an-alveolar-recruitment-maneuver-during-lung-protective-ven-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Youn Yi Jo, Kyung Cheon Lee, Young Jin Chang, Wol Seon Jung, Jongchul Park, Hyun Jeong Kwak Department of Anesthesiology and Pain Medicine, Gachon University College of Medicine, Gil Hospital, Incheon, Republic of KoreaCorrespondence: Hyun Jeong Kwak Email hyun615@gilhospital.comPurpose: Controversy remains over whether alveolar recruitment maneuvers (ARMs) can reduce postoperative pulmonary complications. We hypothesized that performing an ARM in addition to lung protective ventilation (LPV) could improve intraoperative arterial oxygenation and postoperative pulmonary complications (PPCs) in elderly patients undergoing laparoscopy in the Trendelenburg position.Patients and Methods: Sixty-two patients (aged 65– 85) scheduled for laparoscopic low anterior resection were randomized to receive LPV only (LPV group, n = 32) or LPV with an ARM (ARM group, n = 30). LPV was set to a tidal volume of 6 mL/kg with a positive end expiratory pressure (PEEP) of 5 cmH2O. The ARM was performed by serially increasing the PEEP to 10 cmH2O for 3 breaths, 15 cmH2O for 3 breaths, then 20 cmH2O for 10 breaths, both immediately before and after abdominal insufflation. The primary end-point was the frequency of PPCs such as desaturation (SpO2 < 90%), atelectasis, and pneumonia. Secondary end-points were changes in intraoperative respiratory and gas exchange parameters and hemodynamic variables.Results: One patient in the LPV group experienced desaturation on the first postoperative day. The frequency of chest X-ray abnormalities such as atelectasis or pleural effusion was comparable between groups (6 (19%) and 5 (17%) patients, respectively, P = 0.676). Changes in other respiratory, gas exchange and hemodynamic parameters over time were not significantly different between the groups. However, vasopressor requirements during surgery were higher in the ARM than the LPV group (9 (30%) and 2 (6%) patients, respectively, P = 0.014).Conclusion: This study suggests that performing an ARM during LPV may not improve postoperative respiratory outcomes and intraoperative oxygenation compared to LPV alone in geriatric patients undergoing laparoscopy in the Trendelenburg position. In addition, since the ARM could cause a significant deterioration in hemodynamic parameters, applying ARM to elderly patients should be carefully considered.Keywords: alveolar recruitment maneuver, geriatric, lung protective ventilation, pneumoperitoneumJo YYLee KCChang YJJung WSPark JKwak HJDove Medical Pressarticlealveolar recruitment maneuvergeriatriclung protective ventilationpneumoperitoneumGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 15, Pp 1461-1469 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	alveolar recruitment maneuver geriatric lung protective ventilation pneumoperitoneum Geriatrics RC952-954.6
spellingShingle	alveolar recruitment maneuver geriatric lung protective ventilation pneumoperitoneum Geriatrics RC952-954.6 Jo YY Lee KC Chang YJ Jung WS Park J Kwak HJ Effects of an Alveolar Recruitment Maneuver During Lung Protective Ventilation on Postoperative Pulmonary Complications in Elderly Patients Undergoing Laparoscopy
description	Youn Yi Jo, Kyung Cheon Lee, Young Jin Chang, Wol Seon Jung, Jongchul Park, Hyun Jeong Kwak Department of Anesthesiology and Pain Medicine, Gachon University College of Medicine, Gil Hospital, Incheon, Republic of KoreaCorrespondence: Hyun Jeong Kwak Email hyun615@gilhospital.comPurpose: Controversy remains over whether alveolar recruitment maneuvers (ARMs) can reduce postoperative pulmonary complications. We hypothesized that performing an ARM in addition to lung protective ventilation (LPV) could improve intraoperative arterial oxygenation and postoperative pulmonary complications (PPCs) in elderly patients undergoing laparoscopy in the Trendelenburg position.Patients and Methods: Sixty-two patients (aged 65– 85) scheduled for laparoscopic low anterior resection were randomized to receive LPV only (LPV group, n = 32) or LPV with an ARM (ARM group, n = 30). LPV was set to a tidal volume of 6 mL/kg with a positive end expiratory pressure (PEEP) of 5 cmH2O. The ARM was performed by serially increasing the PEEP to 10 cmH2O for 3 breaths, 15 cmH2O for 3 breaths, then 20 cmH2O for 10 breaths, both immediately before and after abdominal insufflation. The primary end-point was the frequency of PPCs such as desaturation (SpO2 < 90%), atelectasis, and pneumonia. Secondary end-points were changes in intraoperative respiratory and gas exchange parameters and hemodynamic variables.Results: One patient in the LPV group experienced desaturation on the first postoperative day. The frequency of chest X-ray abnormalities such as atelectasis or pleural effusion was comparable between groups (6 (19%) and 5 (17%) patients, respectively, P = 0.676). Changes in other respiratory, gas exchange and hemodynamic parameters over time were not significantly different between the groups. However, vasopressor requirements during surgery were higher in the ARM than the LPV group (9 (30%) and 2 (6%) patients, respectively, P = 0.014).Conclusion: This study suggests that performing an ARM during LPV may not improve postoperative respiratory outcomes and intraoperative oxygenation compared to LPV alone in geriatric patients undergoing laparoscopy in the Trendelenburg position. In addition, since the ARM could cause a significant deterioration in hemodynamic parameters, applying ARM to elderly patients should be carefully considered.Keywords: alveolar recruitment maneuver, geriatric, lung protective ventilation, pneumoperitoneum
format	article
author	Jo YY Lee KC Chang YJ Jung WS Park J Kwak HJ
author_facet	Jo YY Lee KC Chang YJ Jung WS Park J Kwak HJ
author_sort	Jo YY
title	Effects of an Alveolar Recruitment Maneuver During Lung Protective Ventilation on Postoperative Pulmonary Complications in Elderly Patients Undergoing Laparoscopy
title_short	Effects of an Alveolar Recruitment Maneuver During Lung Protective Ventilation on Postoperative Pulmonary Complications in Elderly Patients Undergoing Laparoscopy
title_full	Effects of an Alveolar Recruitment Maneuver During Lung Protective Ventilation on Postoperative Pulmonary Complications in Elderly Patients Undergoing Laparoscopy
title_fullStr	Effects of an Alveolar Recruitment Maneuver During Lung Protective Ventilation on Postoperative Pulmonary Complications in Elderly Patients Undergoing Laparoscopy
title_full_unstemmed	Effects of an Alveolar Recruitment Maneuver During Lung Protective Ventilation on Postoperative Pulmonary Complications in Elderly Patients Undergoing Laparoscopy
title_sort	effects of an alveolar recruitment maneuver during lung protective ventilation on postoperative pulmonary complications in elderly patients undergoing laparoscopy
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/848742fe19794fb7a4acb2a4ff47c4bb
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Effects of an Alveolar Recruitment Maneuver During Lung Protective Ventilation on Postoperative Pulmonary Complications in Elderly Patients Undergoing Laparoscopy

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