Individualized Perioperative Open Lung Ventilatory Strategy

Conditions

Moderated-high Risk of Postoperative Pulmonary Complication, Abdominal Surgery Expected More Than Two Hours

Keywords

ventilation, lung, lung complications, postoperative complications, perioperative lung protective ventilation

Brief summary

The purpose of this study is to determine whether individualized ventilatory management combining the use of low tidal volumes, alveolar recruitment maneuvers, individually titrated positive end-expiratory pressure and postoperative individualized ventilatory support will decrease postoperative complications, unplanned ICU readmissions, ICU and hospital length of stay and mortality compared to a standardized Lung Protective Ventilation (LPV) for all patients at risk.

Carlos Ferrando, Julián Librero, Gerardo Tusman, Ary Serpa Neto, Jesús Villar et al. (10 authors)

Acta Anaesthesiologica Scandinavica2021-08-3016 citations

10.1111/aas.13979

Spontaneous recovery of neuromuscular blockade is an independent risk factor for postoperative pulmonary complications after abdominal surgery

Ignacio Garutti, C.L. Errando, Guido Mazzinari, José M. Bellón, Óscar Díaz‐Cambronero et al. (6 authors)

European Journal of Anaesthesiology2020-01-0620 citations

10.1097/eja.0000000000001128

Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial.

Ferrando C, Soro M, Unzueta C, Suarez-Sipmann F, Canet J, Librero J, Pozo N, Peiró S, Llombart A, León I, India I, Aldecoa C, Díaz-Cambronero O, Pestaña D, Redondo FJ, Garutti I, Balust J, García JI, Ibáñez M, Granell M, Rodríguez A, Gallego L, de la Matta M, Gonzalez R, Brunelli A, García J, Rovira L, Barrios F, Torres V, Hernández S, Gracia E, Giné M, García M, García N, Miguel L, Sánchez S, Piñeiro P, Pujol R, García-Del-Valle S, Valdivia J, Hernández MJ, Padrón O, Colás A, Puig J, Azparren G, Tusman G, Villar J, Belda J, Individualized PeRioperative Open-lung VEntilation (iPROVE) Network.

2018-01-19165 citations

10.1016/s2213-2600(18)30024-9

Rationale and study design for an individualized perioperative open lung ventilatory strategy (iPROVE): study protocol for a randomized controlled trial.

Ferrando C, Soro M, Canet J, Unzueta MC, Suárez F, Librero J, Peiró S, Llombart A, Delgado C, León I, Rovira L, Ramasco F, Granell M, Aldecoa C, Diaz O, Balust J, Garutti I, de la Matta M, Pensado A, Gonzalez R, Durán ME, Gallego L, Del Valle SG, Redondo FJ, Diaz P, Pestaña D, Rodríguez A, Aguirre J, García JM, García J, Espinosa E, Charco P, Navarro J, Rodríguez C, Tusman G, Belda FJ, iPROVE investigators (Appendices 1 and 2).

2015-04-2734 citations

10.1186/s13063-015-0694-1

Interventions

PROCEDUREAlveolar recruitment maneuver

To start Alveolar Recruitment Maneuver (ARM), change ventilatory pressure-controlled mode (PCV) with 15 cmH2O pressure control ventilation. A respiratory rate (RR) of 15 rpm, inspiration: expiration ratio of 1:1, FiO2 of 0.8 and PEEP of 10 cmH2O. PEEP level will increase 5 on 5 cmH2O every 10 respiratory cycles, increasing to 15 cycles in the last level of PEEP (25 cmH2O), getting an opening pressure at 40 cmH2O airway (duration of the maneuver: 160 sec.)

PROCEDURECalculation of optimal PEEP

Change ventilation mode to volume controlled ventilation (VCV) with a VT of 8 ml / kg, RR 15 rpm and adjust a PEEP of 20 cmH2O. Descend PEEP level 2 by 2 cmH2O every 30 seconds until obtain the best respiratory system compliance (Crs) PEEP. Once you know the optimal level of PEEP (best Crs PEEP), will be conducted again alveolar recruitment maneuver and adjust the best Crs level of PEEP + 2 cmH2O .

PROCEDUREPostoperative CPAP

Postoperatively, non-invasive mechanical ventilation with a CPAP of 5 cmH2O (or 10 cmH2O if BMI\> 30) with a FiO2 of 0.5 will be applied.

Study design

Allocation

RANDOMIZED

Intervention model

FACTORIAL

Primary purpose

PREVENTION

Masking

SINGLE (Subject)

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

No

Inclusion criteria

* Age not less than 18 * Risk of postoperative pulmonary complication moderate-high defined by a score ≥ 26 on the risk scale ARISCAT (based on the analysis of seven factors, where a score between 26 and 44 points defines a moderate risk, and a score\> 44 points define a high risk, included in the Information Booklet Investigator). * Planned abdominal surgery\> 2 hours. * Signed informed consent for participation in the study.

Exclusion criteria

* Age less than 18 years. * Pregnant or breast-feeding. * Patients with BMI \>35. * Syndrome of moderate or severe respiratory distress: PaO2/FiO2 \< 200 mmHg. * Heart failure: NYHA IV. * Hemodynamic failure: CI \<2.5 L/min/m2 and / or requirements before surgery ionotropic support. * Diagnosis or suspicion of intracranial hypertension (intracranial pressure\> 15 mmHg). * Mechanical ventilation in the last 15 days. * Presence of pneumothorax. Presence of giant bullae on chest radiography or computed tomography (CT). * Patient with preoperatively CPAP. * Participation in another experimental protocol at the time of intervention selection.

Design outcomes

Primary

Measure	Time frame
Reduction of lung and systemic postoperative complications	Up to 7 postoperative days

Secondary

Measure	Time frame
Reduction of lung and systemic postoperative complications	Up to 30 postoperative days

Other

Measure	Time frame
Mortality evaluation	180 and 365 days postoperative

Countries

Argentina, Spain, Sweden, United States

Outcome results

None listed