The impact of tidal volume on pulmonary complications following minimally invasive esophagectomy: A randomized and controlled study

Shen, Yaxing; Zhong, Ming; Wu, Wei; Wang, Hao; Feng, Mingxiang; Tan, Lijie; Wang, Qun

doi:10.1016/j.jtcvs.2013.06.043

Cited by 81 publications

(52 citation statements)

References 30 publications

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“…2). 33,35,[40][41][42][43][44][45][46] Cardiac surgery with cardiopulmonary bypass in and of itself is associated with a systemic and pulmonary inflammation. 47 Cardiopulmonary bypass-related systemic inflammatory response syndrome represents an important first hit for lung injury, and the use of high V T values during the surgery may act as the second hit that worsens lung damage.…”

Section: Ventilation Of Surgical Patientsmentioning

confidence: 99%

Should A Tidal Volume of 6 mL/kg Be Used in All Patients?

2016

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It has been shown that mechanical ventilation by itself can cause lung injury and affect outcomes. Ventilator-induced lung injury is associated with high tidal volumes in lungs afflicted with ARDS. However, the question is: Do high tidal volumes have this same effect in normal lungs or lungs that have respiratory compromise stemming from something other than ARDS? Many clinicians believe that a tidal volume strategy of 6 mL/kg predicted body weight should be standard practice in all patients receiving mechanical ventilation. There is a growing body of evidence related to this issue, and this is the debate that will be tackled in this paper from both pro and con perspectives. Key words: tidal volume; predicted body weight; mechanical ventilation; lung-protective ventilation; time constant; ARDS; stress; strain; hypercapnia. [Respir Care 2016;61(6):774 -790 . © 2016 Daedalus Enterprises] IntroductionIt is well known that the use of mechanical ventilation has the potential to aggravate pulmonary injury, but emerging evidence indicates that it may also precipitate lung injury in patients with no previous injury. Lung-protective ventilation has evolved over the past couple of decades to the point that it has become standard of care for patients with ARDS. The use of lower tidal volume (V T ) 4 -8 mL/kg predicted body weight (PBW) is part of this lung-protective strategy for mechanical ventilation (mechanical ventilation) along with limiting the plateau pressure to a maximum of 30 cm H 2 O and prudent use of PEEP to prevent atelectasis. Since we now know that the use of lower V T strategies (more specifically 6 mL/kg PBW) helps to limit the pulmonary damage during ARDS, the question now is: Should we be using this strategy in all mechanically ventilated patients? Anatomically speaking, it makes sense to, since the normal physiologic V T for humans is approximately 6 mL/kg PBW. 1 There is a growing body of evidence that points toward the use of lower V T values leading to improved outcomes in patients suffering from other forms and degrees of respiratory failure. The aim of this paper is to examine the evidence relating to the use of lower V T values in conditions other than ARDS in which mechanical ventilation is required. This will be done with viewpoints from both the pro and con positions. Early StudiesThere is a plethora of preclinical evidence from animal studies supporting the fact that the use of high V T values can directly cause injury to normal lungs. Animal studies have shown that high V T ventilation increases levels of pro-inflammatory mediators, leads to pulmonary edema, and causes increased alveolar-capillary permeability and structural abnormalities. [2][3][4][5][6][7][8] With the emergence of these animal data, clinicians began to question the traditional use of V T values in the range of 10 -15 mL/kg PBW in humans. Several small human studies were reported in the mid-to late 1990s that produced conflicting results. 9-11 These studies were hampered by several factors, including higher than predicte...

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Section: Ventilation Of Surgical Patientsmentioning

confidence: 99%

Should A Tidal Volume of 6 mL/kg Be Used in All Patients?

2016

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“…Other studies demonstrated an association between small intraoperative V T with minimal PEEP and an increased risk of mortality and postoperative complications: low PEEP appears to be insufficient to stabilize alveoli, reduce alveolar strain, and prevent atelectasis (28,29). Application of PEEP is essential to safeguard the lung in surgical patients ventilated with both small and large V T , by improving lung function and reducing the risk of postoperative complications after OLV (13,14,30). In light of the current evidence, it could be suggested that a small V T does not in itself prevent postoperative respiratory complications without adequate PEEP, and it is interesting to note that in the most important studies, the duration of OLV was longer than that used in the present study ( Table 3).…”

Section: Discussionmentioning

confidence: 99%

“…The duration of OLV seems to be one of the major factors influencing a patients' outcome, aside from the quality of postoperative analgesia and intraoperative fluid therapy, in positive correlation with the length of an ICU stay (34). If put into practice, approaches and techniques that would achieve the optimization of these factors could improve patient outcome and reduce critical care resources required for patients undergoing thoracic surgery (30).…”

Section: Discussionmentioning

confidence: 99%

Short-term one-lung ventilation does not influence local inflammatory cytokine response after lung resection

et al. 2018

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Background: One-lung ventilation (OLV) is a ventilation procedure used for pulmonary resection which may results in lung injury. The aim of this study was to evaluate the local inflammatory cytokine response from the dependent lung after OLV and its correlation to VT. The secondary aim was to evaluate the clinical outcome of each patient. Methods: Twenty-eight consecutive patients were enrolled. Ventilation was delivered in volume-controlled mode with a VT based on predicted body weight (PBW). 5 cmH 2 O positive end-expiratory pressure (PEEP) and FiO 2 0.5 were applied. Bronchoalveolar lavage (BAL) was performed in the dependent lung before and after OLV. The levels of pro-inflammatory interleukins (IL-1α, IL-1β, IL-6, IL-8), tumor necrosis factor alpha (TNFα), vascular endothelial growth factor (VEGF), endothelial growth factor (EGF), monocyte chemoattractant protein-1 (MCP-1) and anti-inflammatory cytokines, such as interleukins (IL-2, IL-4, IL-10) and interferon (IFN-γ), were evaluated. Subgroup analysis: to analyze the VT setting during OLV, all patients were ventilated within a range of 5-10 mL/kg. Thirteen patients, classified as a conventional ventilation (CV) subgroup, received 8-10 mL/kg, while 15 patients, classified as a protective ventilation (PV) subgroup, received 5-7 mL/kg.Results: Cytokine BAL levels after surgery showed no significant increase after OLV, and no significant differences were recorded between the two subgroups. The mean duration of OLV was 64.44±21.68 minutes.No postoperative respiratory complications were recorded. The mean length of stay was for 4.00±1.41 days in the PV subgroup and 4.45±2.07 days in the CV group; no statistically significant differences were recorded between the two subgroups (P=0.511). Conclusions: Localized inflammatory cytokine response after OLV was not influenced by the use of different VT. Potentially, the application of PEEP in both ventilation strategies and the short duration of OLV could prevent postoperative complications.

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“…Further, the pathophysiologic relevance of capnothorax was also investigated by Mao et al [25] who found relevant impairment of the coagulatory system in patients after capnothorax. Also, experimental work by Shen et al [26 ]demonstrated that changes in pulmonary management with low-volume insufflation significantly reduced postoperative pulmonary complications in patients undergoing esophagectomy with cervical anastomosis. Robotic-assisted minimally invasive esophagectomy (RAMIE) is technically equivalent to total MIE and mainly performed in the setting of single-lung ventilation; however, the steady image and the exact movement of the instruments may further reduce the physiologic alterations during the operation.…”

Section: Types Of Minimally Invasive Esophageal Resectionmentioning

confidence: 99%

Upper Gastrointestinal Surgery: Robotic Surgery versus Laparoscopic Procedures for Esophageal Malignancy

Biebl¹,

Ανδρέου²,

Chopra³

et al. 2018

Visc Med

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Background: The evolution of minimally invasive surgery (MIS) also extends to the field of esophageal surgery and has brought forth the development of several approaches of minimally invasive esophagectomy (MIE). Hybrid and total minimally invasive operative techniques have proven beneficial compared to open surgery and are currently evaluated against robotic-assisted minimally invasive esophagectomy (RAMIE). We aim to review the current literature regarding the position of MIE versus RAMIE. Methods: A systematic review of the relevant literature on minimally invasive esophageal surgery for cancer is presented. A PubMed search was carried out for the period of 1992-2018 with the following search terms: ‘esophageal cancer', ‘minimally invasive surgery', ‘resection', ‘transhiatal', ‘transthoracic', ‘MIE', ‘hybrid', ‘robotic resection', ‘RAMIE', ‘RATE'. Results: Hybrid and total minimally invasive operative techniques have proven beneficial, especially with regard to pulmonary complications, compared to open surgery. Oncologic outcomes appear equivalent between open and minimally invasive techniques. Currently, the position of RAMIE is being evaluated against other minimally invasive techniques. Conclusion: All minimally invasive techniques confer the expected reduction in perioperative morbidity compared to open surgery. However, MIS is still evolving with regard to specific technical challenges, especially anastomotic techniques.

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The impact of tidal volume on pulmonary complications following minimally invasive esophagectomy: A randomized and controlled study

Cited by 81 publications

References 30 publications

Should A Tidal Volume of 6 mL/kg Be Used in All Patients?

Should A Tidal Volume of 6 mL/kg Be Used in All Patients?

Short-term one-lung ventilation does not influence local inflammatory cytokine response after lung resection

Upper Gastrointestinal Surgery: Robotic Surgery versus Laparoscopic Procedures for Esophageal Malignancy

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