Effect of individualized PEEP titration by ultrasonography on perioperative pulmonary protection and postoperative cognitive function in patients with chronic obstructive pulmonary disease

Luo, Liying; Lin, Yan‐Hui; Liu, Ying; Gao, Xiang; Li, Chui-Yu; Zhang, Xiaoqi; Wu, Jing; Chen, Zhi-yuan

doi:10.1186/s12890-023-02471-y

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…The stepwise method using slow-low pressure can achieve lung recruitment while reducing impact on the circulatory system ( 13 , 14 ). LNVP strategy used sustained inflation, higher PEEP, and peak pressure threshold, but this setting violated the protective lung ventilation strategy and may lead to ventilator-related lung injury ( 5 , 6 , 15 - 17 ). In our early cases, we followed the LNVP strategy and found that patients were prone to intraoperative bleeding and hypotension and decreased oxygenation index.…”

Section: Discussionmentioning

confidence: 99%

Intraprocedural computed tomography-guided navigation with ventilatory strategy for atelectasis (ICNVA): a modified electromagnetic navigation bronchoscopy

Dai,

Xu,

Chen

et al. 2024

J Thorac Dis

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Background Computed tomography (CT)-body divergence limits the accuracy of electromagnetic navigation bronchoscopy (ENB) in peripheral lung lesions diagnosis. We developed intraprocedural CT-guided navigation with ventilatory strategy for atelectasis (ICNVA) ENB for patients with peripheral lung lesions. Methods Retrospective observational study in which ten consecutive patients with pulmonary lesions (without bronchial direct connection) underwent ICNVA-ENB was conducted. During ICNVA-ENB, intraoperative CT data were used for ENB path planning, and a new ventilation strategy were employed to help maintain the pulmonary region in a static and inflation state which reduce CT to body divergence. We collected three sets of CT data: preENB CT, post-anesthesia intubation CT, and postENB CT. To evaluate the accuracy of ICNVA-ENB, we measured the distance between the ENB probe and the actual lesion location, but also recorded the results of rapid on-site evaluation (ROSE), and postoperative pathology. To evaluate the impact of CT-body divergence induced by atelectasis, we calculated the mutual position distance of target lesions in preENB CT, post-anesthesia intubation CT and postENB CT. Furthermore, ENB operation time and operative complications were recorded. Results Our analysis revealed that the distance between the navigation probe with the actual location of lesion center was 4–10 (5.90±1.73) mm. The ROSE results were consistent with the postoperative pathological diagnosis in 9 out of 10 patients (90%). The ICNVA-ENB atelectasis CT-body divergence was smaller than traditional ENB (12.10±3.67 vs. 6.60±2.59 mm, P<0.01). The ENB operation time was 20–53 (29.30±10.14) minutes and one patient developed slight intrapulmonary hemorrhage. Conclusions ICNVA-ENB can reduce the CT-body divergence and appears to be safe and accurate for patients with peripheral lung lesions.

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Section: Discussionmentioning

confidence: 99%

Intraprocedural computed tomography-guided navigation with ventilatory strategy for atelectasis (ICNVA): a modified electromagnetic navigation bronchoscopy

Dai,

Xu,

Chen

et al. 2024

J Thorac Dis

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“… 9 10 An optimal PEEP level should strike a balance between maintaining alveolar patency and preventing overexpansion, 11 a balance that has been associated with enhanced oxygenation and reduced lung injury. 12 According to an international expert panel-based consensus, an initial PEEP setting of 5 cm H 2 O is recommended, with subsequent PEEP levels should be individualised. 13 …”

Section: Introductionmentioning

confidence: 99%

Effects of individualised lung-protective ventilation with lung dynamic compliance-guided positive end-expiratory pressure titration on postoperative pulmonary complications of paediatric video-assisted thoracoscopic surgery: protocol for a randomised controlled trial

Chen,

Lin,

Shi

et al. 2024

bmjpo

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IntroductionLung-protective ventilation strategies (LPVS) for one-lung ventilation (OLV) in paediatric patients pose greater challenges than in adults. Optimising LPVS for paediatric OLV to mitigate postoperative pulmonary complications (PPCs) has emerged as a current research focal point. However, there remains a divergence of opinions concerning the individualised setting and application of positive end-expiratory pressure (PEEP). Lung dynamic compliance (Cdyn) can serve as a reflection of the lung’s physiological state in children during OLV and is a readily obtainable parameter. This study protocol is formulated to assess the effectiveness of Cdyn-guided PEEP titration on PPCs during paediatric OLV.Methods and analysisThis study constitutes a single-centre, prospective, double-blind, randomised controlled trial. The trial aims to recruit 60 paediatric patients scheduled for video-assisted thoracoscopic surgery. These eligible patients will be randomly assigned to either the Cdyn-guided PEEP group or the conventional PEEP group during general anaesthesia for OLV. The primary outcome will involve assessing the incidence of PPCs at 7 days after surgery. Secondary outcomes will encompass the evaluation of the modified lung ultrasound score following surgery, as well as monitoring the oxygenation index, driving pressure and Cdyn during mechanical ventilation. Data collection will be performed by investigators who are kept blinded to the interventions.Ethics and disseminationThe Clinical Trial Ethics Committee at Shenzhen Children’s Hospital has conferred ethical approvals for this trial (approval number: 2022076). Results from this trial will be disseminated in peer-reviewed journals and presented at professional symposiums.Trail registration numberNCT05386901.

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Individualised Positive End-Expiratory Pressure Settings Reduce the Incidence of Postoperative Pulmonary Complications: A Systematic Review and Meta-Analysis

Szigetváry,

Szabó,

Dembrovszky

et al. 2024

JCM

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Background: Progressive atelectasis regularly occurs during general anaesthesia; hence, positive end-expiratory pressure (PEEP) is often applied. Individualised PEEP titration may reduce the incidence of postoperative pulmonary complications (PPCs) and improve oxygenation as compared to fixed PEEP settings; however, evidence is lacking. Methods: This systematic review and meta-analysis was registered on PROSPERO (CRD42021282228). A systematic search in four databases (MEDLINE Via PubMed, EMBASE, CENTRAL, and Web of Science) was performed on 14 October 2021 and updated on 26 April 2024. We searched for randomised controlled trials comparing the effects of individually titrated versus fixed PEEP strategies during abdominal surgeries. The primary endpoint was the incidence of PPCs. The secondary endpoints included the PaO2/FiO2 at the end of surgery, individually set PEEP value, vasopressor requirements, and respiratory mechanics. Results: We identified 30 trials (2602 patients). The incidence of PPCs was significantly lower among patients in the individualised group (RR = 0.70, CI: 0.58–0.84). A significantly higher PaO2/FiO2 ratio was found in the individualised group as compared to controls at the end of the surgery (MD = 55.99 mmHg, 95% CI: 31.78–80.21). Individual PEEP was significantly higher as compared to conventional settings (MD = 6.27 cm H2O, CI: 4.30–8.23). Fewer patients in the control group needed vasopressor support; however, this result was non-significant. Lung-function-related outcomes showed better respiratory mechanics in the individualised group (Cstat: MD = 11.92 cm H2O 95% CI: 6.40–17.45). Conclusions: Our results show that individually titrated PEEP results in fewer PPCs and better oxygenation in patients undergoing abdominal surgery.

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Effect of individualized PEEP titration by ultrasonography on perioperative pulmonary protection and postoperative cognitive function in patients with chronic obstructive pulmonary disease

Cited by 3 publications

References 24 publications

Intraprocedural computed tomography-guided navigation with ventilatory strategy for atelectasis (ICNVA): a modified electromagnetic navigation bronchoscopy

Intraprocedural computed tomography-guided navigation with ventilatory strategy for atelectasis (ICNVA): a modified electromagnetic navigation bronchoscopy

Effects of individualised lung-protective ventilation with lung dynamic compliance-guided positive end-expiratory pressure titration on postoperative pulmonary complications of paediatric video-assisted thoracoscopic surgery: protocol for a randomised controlled trial

Individualised Positive End-Expiratory Pressure Settings Reduce the Incidence of Postoperative Pulmonary Complications: A Systematic Review and Meta-Analysis

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