Intraoperative protective ventilation in patients undergoing major neurosurgical interventions: a randomized clinical trial.
Adult
Aged
Female
Hospitalization
/ statistics & numerical data
Hospitals, University
Humans
Intensive Care Units
/ statistics & numerical data
Intraoperative Care
/ methods
Italy
Length of Stay
Lung Diseases
/ prevention & control
Male
Middle Aged
Neurosurgical Procedures
/ methods
Pilot Projects
Positive-Pressure Respiration
/ methods
Postoperative Complications
/ epidemiology
Respiration, Artificial
/ methods
Mechanical ventilation
Neurosurgery
Postoperative pulmonary complications
Journal
BMC anesthesiology
ISSN: 1471-2253
Titre abrégé: BMC Anesthesiol
Pays: England
ID NLM: 100968535
Informations de publication
Date de publication:
30 06 2021
30 06 2021
Historique:
received:
01
11
2020
accepted:
17
06
2021
entrez:
30
6
2021
pubmed:
1
7
2021
medline:
6
1
2022
Statut:
epublish
Résumé
Post-operative pulmonary complications (PPC) can develop in up to 13% of patients undergoing neurosurgical procedures and may adversely affect clinical outcome. The use of intraoperative lung protective ventilation (LPV) strategies, usually including the use of a low V This single-centre, pilot randomized clinical trial was conducted at the University Hospital "Maggiore della Carità" (Novara, Italy). Adult patients undergoing major cerebral or spinal neurosurgical interventions with risk index for pulmonary post-operative complications > 2 and not expected to need post-operative intensive care unit (ICU) admission were considered eligible. Patients were randomly assigned to either LPV (Vt = 6 ml/kg of ideal body weight (IBW), respiratory rate initially set at 16 breaths/min, PEEP at 5 cmH2O and application of a recruitment manoeuvre (RM) immediately after intubation and at every disconnection from the ventilator) or control treatment (Vt = 10 ml/kg of IBW, respiratory rate initially set at 6-8 breaths/min, no PEEP and no RM). Primary outcomes of the study were intraoperative adverse events, the level of cerebral tension at dura opening and the intraoperative control of PaCO A total of 60 patients, 30 for each group, were randomized. During brain surgery, the number of episodes of intraoperative hypercapnia and grade of cerebral tension were similar between patients randomized to receive control or LPV strategies. No difference in the rate of intraoperative adverse events was found between groups. The rate of postoperative pulmonary and extrapulmonary complications and major clinical outcomes were similar between groups. LPV strategies in patients undergoing major neurosurgical intervention are feasible. Larger clinical trials are needed to assess their role in postoperative clinical outcome improvements. registered on the Australian New Zealand Clinical Trial Registry ( www.anzctr.org.au ), registration number ACTRN12615000707561.
Sections du résumé
BACKGROUND
Post-operative pulmonary complications (PPC) can develop in up to 13% of patients undergoing neurosurgical procedures and may adversely affect clinical outcome. The use of intraoperative lung protective ventilation (LPV) strategies, usually including the use of a low V
METHODS
This single-centre, pilot randomized clinical trial was conducted at the University Hospital "Maggiore della Carità" (Novara, Italy). Adult patients undergoing major cerebral or spinal neurosurgical interventions with risk index for pulmonary post-operative complications > 2 and not expected to need post-operative intensive care unit (ICU) admission were considered eligible. Patients were randomly assigned to either LPV (Vt = 6 ml/kg of ideal body weight (IBW), respiratory rate initially set at 16 breaths/min, PEEP at 5 cmH2O and application of a recruitment manoeuvre (RM) immediately after intubation and at every disconnection from the ventilator) or control treatment (Vt = 10 ml/kg of IBW, respiratory rate initially set at 6-8 breaths/min, no PEEP and no RM). Primary outcomes of the study were intraoperative adverse events, the level of cerebral tension at dura opening and the intraoperative control of PaCO
RESULTS
A total of 60 patients, 30 for each group, were randomized. During brain surgery, the number of episodes of intraoperative hypercapnia and grade of cerebral tension were similar between patients randomized to receive control or LPV strategies. No difference in the rate of intraoperative adverse events was found between groups. The rate of postoperative pulmonary and extrapulmonary complications and major clinical outcomes were similar between groups.
CONCLUSIONS
LPV strategies in patients undergoing major neurosurgical intervention are feasible. Larger clinical trials are needed to assess their role in postoperative clinical outcome improvements.
TRIAL REGISTRATION
registered on the Australian New Zealand Clinical Trial Registry ( www.anzctr.org.au ), registration number ACTRN12615000707561.
Identifiants
pubmed: 34187530
doi: 10.1186/s12871-021-01404-8
pii: 10.1186/s12871-021-01404-8
pmc: PMC8241565
doi:
Types de publication
Comparative Study
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
184Références
Lancet Respir Med. 2016 Apr;4(4):272-80
pubmed: 26947624
Anesthesiology. 1998 May;88(5):1365-86
pubmed: 9605698
J Neurosurg Anesthesiol. 2018 Jul;30(3):237-245
pubmed: 28338504
Indian J Anaesth. 2020 Feb;64(2):90-96
pubmed: 32139925
Lancet. 2014 Aug 9;384(9942):495-503
pubmed: 24894577
Crit Care. 2009;13(2):R41
pubmed: 19317902
Ann Intern Med. 2001 Apr 17;134(8):663-94
pubmed: 11304107
Lancet. 2008 Jul 12;372(9633):139-44
pubmed: 18582931
Br J Neurosurg. 1996 Feb;10(1):69-75
pubmed: 8672261
Anesth Analg. 2020 Dec;131(6):1721-1729
pubmed: 33186160
Anesthesiology. 2013 Jun;118(6):1307-21
pubmed: 23542800
Anesthesiology. 2014 Aug;121(2):219-31
pubmed: 24901240
Vet J. 2013 Sep;197(3):800-5
pubmed: 23791733
Eur J Anaesthesiol. 2017 Aug;34(8):492-507
pubmed: 28633157
JAMA Surg. 2017 Feb 1;152(2):157-166
pubmed: 27829093
Anesthesiology. 2015 Jul;123(1):66-78
pubmed: 25978326
Crit Care Med. 2004 Dec;32(12):2378-84
pubmed: 15599139
Anesthesiology. 2011 May;114(5):1102-10
pubmed: 21430518
J Clin Anesth. 2012 Jun;24(4):263-9
pubmed: 22001758
J Cereb Blood Flow Metab. 2001 Aug;21(8):937-44
pubmed: 11487729
BMC Anesthesiol. 2020 Apr 2;20(1):73
pubmed: 32241266
Eur J Anaesthesiol. 2012 Aug;29(8):371-9
pubmed: 22569025
N Engl J Med. 2013 Aug 1;369(5):428-37
pubmed: 23902482
Anesthesiology. 2015 Jan;122(1):196-205
pubmed: 25401418
J Neurosurg Anesthesiol. 2018 Oct;30(4):328-336
pubmed: 29135700
Anesthesiology. 2012 May;116(5):1072-82
pubmed: 22450472
JAMA. 2020 Sep 1;324(9):848-858
pubmed: 32870298
Ann Intern Med. 2001 Nov 20;135(10):847-57
pubmed: 11712875
JAMA. 2006 Oct 18;296(15):1851-7
pubmed: 17047215
Am J Respir Crit Care Med. 2008 Dec 1;178(11):1156-63
pubmed: 18776154
JAMA. 2019 Jun 18;321(23):2292-2305
pubmed: 31157366
Br J Anaesth. 2019 Dec;123(6):898-913
pubmed: 31587835