J Korean Med Sci.  2020 Oct;35(39):e327. 10.3346/jkms.2020.35.e327.

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

• Cho S
• Oh HW
• Choi MH
• Lee HJ
• Woo JH

• KMID: 2507607
• DOI: http://doi.org/10.3346/jkms.2020.35.e327

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 cmH 2 O 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.

Keyword

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

Figure

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  Fig. 1 LUS score. The degree of aeration loss was graded depending on juxtapleural consolidation (arrow) and B lines (arrow head). (A) 0, normal aeration (0–2 B lines); (B) 1, small loss of aeration (≥ 3 B lines or multiple small juxtapleural consolidations separated by a normal pleural line); (C) 2, moderate loss of aeration (C1: coalescent B lines or C2: multiple small juxtapleural consolidations separated by a thickened or irregular pleural line); No patients exhibited severe loss of aeration corresponding to a LUS score of 3 points.LUS = lung ultrasound.

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  Fig. 2 The consolidated standards of reporting trials statement.

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  Fig. 3 Relationship between the changes in the LUS scores and the changes in the PaO2/FiO2 ratio using Spearman's correlation coefficients (rs). The change was calculated between 5 minutes after anesthesia induction and the end of surgery.LUS = lung ultrasound.

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