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 ( $V_T$ ) 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 ${}^{-1}$ $V_T$ ; CV group) or LPV ( $V_T$ was adjusted to a target Pplat [ $⩽$ 20 cm H ${}_2$ O]) in the volume-controlled mode with PEEP (9 cm H ${}_2$ O; LPV group) ventilation.

RESULTS:

Patients in the LPV group showed significantly lower pH values (7.30 $\pm$ 0.07 vs. 7.38 $\pm$ 0.05, $P<$ 0.001) and respiratory indexes than that of CV group (0.806 $\pm$ 0.339 vs. 0.919 $\pm$ 0.300, $P=$ 0.043) at the end of surgery. Compared with the CV group, the dynamic lung compliance (33.39 $\pm$ 3.163 vs. 30.15 $\pm$ 2.572, $P<$ 0.001) was significantly higher, and the body temperature remained significantly more favorable in the LPV group (35.9 $\pm$ 0.3 vs. 35.1 $\pm$ 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.