Rationale and study design for an Individualized PeriopeRative Open lung VEntilatory approach in Emergency Abdominal Laparotomy/scopy: study protocol for a prospective international randomized controlled trial.

Complicaciones pulmonares postoperatorias Postoperative pulmonary complications cirugía de urgencia emergency surgery estrategia ventilatoria a pulmón abierto maniobras de reclutamiento open lung ventilatory strategy recruitment maneuvers

Journal

Revista espanola de anestesiologia y reanimacion
ISSN: 2341-1929
Titre abrégé: Rev Esp Anestesiol Reanim (Engl Ed)
Pays: Spain
ID NLM: 101778594

Informations de publication

Date de publication:
16 Apr 2024
Historique:
medline: 19 4 2024
pubmed: 19 4 2024
entrez: 18 4 2024
Statut: aheadofprint

Résumé

Postoperative pulmonary complications (PPC) are the most frequent postoperative complications, with an estimated prevalence in elective surgery ranging from 20% in observational cohort studies to 40% in randomized clinical trials. However, the prevalence of PPCs in patients undergoing emergency abdominal surgery is not well defined. Lung-protective ventilation aims to minimize ventilator-induced lung injury and reduce PPCs. The open lung approach (OLA), which combines recruitment manoeuvres (RM) and positive end-expiratory pressure (PEEP) titration, aims to minimize areas of atelectasis and the development of PPCs; however, there is no conclusive evidence in the literature that OLA can prevent PPCs. The purpose of this study is to compare an individualized perioperative OLA with conventional standardized lung-protective ventilation in patients undergoing emergency abdominal surgery with clinical signs of intraoperative lung collapse. Randomized international clinical trial to compare an individualized perioperative OLA (RM plus individualized PEEP and individualized postoperative respiratory support) with conventional lung-protective ventilation (standard PEEP of 5 cmH The Individualized Perioperative Open-lung Ventilatory Strategy in emergency abdominal laparotomy (iPROVE-EAL) is the first multicentre, randomized, controlled trial to investigate whether an individualized perioperative approach prevents PPCs in patients undergoing emergency surgery.

Sections du résumé

BACKGROUND BACKGROUND
Postoperative pulmonary complications (PPC) are the most frequent postoperative complications, with an estimated prevalence in elective surgery ranging from 20% in observational cohort studies to 40% in randomized clinical trials. However, the prevalence of PPCs in patients undergoing emergency abdominal surgery is not well defined. Lung-protective ventilation aims to minimize ventilator-induced lung injury and reduce PPCs. The open lung approach (OLA), which combines recruitment manoeuvres (RM) and positive end-expiratory pressure (PEEP) titration, aims to minimize areas of atelectasis and the development of PPCs; however, there is no conclusive evidence in the literature that OLA can prevent PPCs. The purpose of this study is to compare an individualized perioperative OLA with conventional standardized lung-protective ventilation in patients undergoing emergency abdominal surgery with clinical signs of intraoperative lung collapse.
METHODS METHODS
Randomized international clinical trial to compare an individualized perioperative OLA (RM plus individualized PEEP and individualized postoperative respiratory support) with conventional lung-protective ventilation (standard PEEP of 5 cmH
DISCUSSION CONCLUSIONS
The Individualized Perioperative Open-lung Ventilatory Strategy in emergency abdominal laparotomy (iPROVE-EAL) is the first multicentre, randomized, controlled trial to investigate whether an individualized perioperative approach prevents PPCs in patients undergoing emergency surgery.

Identifiants

DOI: 10.1016/j.redare.2024.04.007 PMID: 38636796
pubmed: 38636796
pii: S2341-1929(24)00075-1
doi: 10.1016/j.redare.2024.04.007
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Auteurs

G Laguna (G)

Departamento de Anestesia y Cuidados Críticos, Hospital Clínic, Barcelona, Spain. Electronic address: glaguna.ri@gmail.com.

F Suárez-Sipmann (F)

Unidad de Cuidados Intensivos, Hospital Universitario, Madrid, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.

G Tusman (G)

Departamento de Anestesia, Hospital Privado de Comunidad, Mar de Plata, Argentina.

J Ripollés (J)

Departamento de Anestesia, Hospital Infanta Leonor de Madrid, Spain.

O Díaz-Cambronero (O)

Departamento de Anestesia, Hospital La Fe de Valencia, Spain.

R Pujol (R)

Departamento de Anestesia y Cuidados Críticos, Hospital Clínic, Barcelona, Spain.

E Rivas (E)

Departamento de Anestesia y Cuidados Críticos, Hospital Clínic, Barcelona, Spain.

I Garutti (I)

Departamento de Anestesia, Hospital Universitario Gregorio Marañón, Madrid, Spain.

R Mellado (R)

Departamento de Anestesia y Cuidados Críticos, Hospital Clínic, Barcelona, Spain.

J Vallverdú (J)

Departamento de Anestesia y Cuidados Críticos, Hospital Clínic, Barcelona, Spain.

A Jacas (A)

Departamento de Anestesia y Cuidados Críticos, Hospital Clínic, Barcelona, Spain.

A Fervienza (A)

Departamento de Anestesia y Cuidados Críticos, Hospital Clínic, Barcelona, Spain.

R Marrero (R)

Departamento de Anestesia y Cuidados Críticos, Hospital Clínic, Barcelona, Spain.

J Librero (J)

Navarrabiomed-Fundación Miguel Servet, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain.

J Villar (J)

CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Red Multidisciplinar de Investigación en Evaluación de Disfunción de Órganos, Unidad de Investigación, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain.

C Ferrando (C)

CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Departamento de Anestesia y Cuidados Críticos, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, Spain.

Classifications MeSH