Intraoperative lung-protective ventilation adjusting tidal volume to a plateau pressure restriction in elderly patients: A randomized controlled clinical trial

Abstract

BACKGROUND: Lung-protective ventilation (LPV) strategies have been considered as best practice in the care of critically patients. OBJECTIVE: This study aimed to investigate the effects individualized perioperative LPV with a positive end-expiratory pressure (PEEP) and low tidal volumes (VT) based on a target airway plateau pressure (Pplat) in patients during and after an operation compared with conventional ventilation in elderly patients during abdominal surgery. METHODS: Sixty-one elderly patients with American Society of Anesthesiologists (ASA) I to III undergoing open abdominal surgery received either conventional ventilation (8 ml/kg-1VT; CV group) or LPV (VT was adjusted to a target Pplat [⩽ 20 cm H2O]) in the volume-controlled mode with PEEP (9 cm H2O; LPV group) ventilation. RESULTS: Patients in the LPV group showed significantly lower pH values (7.30 ± 0.07 vs. 7.38 ± 0.05, P< 0.001) and respiratory indexes than that of CV group (0.806 ± 0.339 vs. 0.919 ± 0.300, P= 0.043) at the end of surgery. Compared with the CV group, the dynamic lung compliance (33.39 ± 3.163 vs. 30.15 ± 2.572, P< 0.001) was significantly higher, and the body temperature remained significantly more favorable in the LPV group (35.9 ± 0.3 vs. 35.1 ± 0.4, P< 0.001). Patients in the LPV group had significantly faster postoperative recovery than that of the CV group (P< 0.001). CONCLUSIONS: The study showed that LPV could be beneficial for ventilation, core body temperature, and postoperative recovery in elderly patients with healthy lungs.