Author:

Keywords:

Science & Technology, Life Sciences & Biomedicine, Anesthesiology, adverse effects, lung injury, perioperative, positive end-expiratory pressure, positive-pressure respiration, postoperative pulmonary complications, tidal volume, END-EXPIRATORY-PRESSURE, POSITIVE-AIRWAY-PRESSURE, POSTOPERATIVE PULMONARY COMPLICATIONS, MORBIDLY OBESE-PATIENTS, LOW-TIDAL-VOLUME, OPEN ABDOMINAL-SURGERY, ALVEOLAR RECRUITMENT STRATEGY, FUNCTIONAL RESIDUAL CAPACITY, INSPIRATORY OXYGEN FRACTION, OBSTRUCTIVE SLEEP-APNEA, Humans, International Cooperation, Intraoperative Care, Lung Diseases, Perioperative Care, Postoperative Complications, Respiration, Artificial, 1103 Clinical Sciences, 3202 Clinical sciences

Abstract:

Postoperative pulmonary complications (PPCs) occur frequently and are associated with substantial morbidity and mortality. Evidence suggests that reduction of PPCs can be accomplished by using lung-protective ventilation strategies intraoperatively, but a consensus on perioperative management has not been established. We sought to determine recommendations for lung protection for the surgical patient at an international consensus development conference. Seven experts produced 24 questions concerning preoperative assessment and intraoperative mechanical ventilation for patients at risk of developing PPCs. Six researchers assessed the literature using questions as a framework for their review. The modified Delphi method was utilised by a team of experts to produce recommendations and statements from study questions. An expert consensus was reached for 22 recommendations and four statements. The following are the highlights: (i) a dedicated score should be used for preoperative pulmonary risk evaluation; and (ii) an individualised mechanical ventilation may improve the mechanics of breathing and respiratory function, and prevent PPCs. The ventilator should initially be set to a tidal volume of 6-8 ml kg-1 predicted body weight and positive end-expiratory pressure (PEEP) 5 cm H2O. PEEP should be individualised thereafter. When recruitment manoeuvres are performed, the lowest effective pressure and shortest effective time or fewest number of breaths should be used.