Different positive end expiratory pressure and tidal volume controls on lung protection and inflammatory factors during surgical anesthesia

doi:10.12998/wjcc.v10.i33.12146

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World Journal of Clinical Cases

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World J Clin Cases. Nov 26, 2022; 10(33): 12146-12155
Published online Nov 26, 2022. doi: 10.12998/wjcc.v10.i33.12146

Different positive end expiratory pressure and tidal volume controls on lung protection and inflammatory factors during surgical anesthesia

Yu Wang, Yi Yang, Ding-Mu Wang, Jie Li, Quan-Tang Bao, Bei-Bei Wang, Shu-Jun Zhu, Lu Zou

Yu Wang, Ding-Mu Wang, Quan-Tang Bao, Bei-Bei Wang, Shu-Jun Zhu, Department of Anesthesia, Xinghua City People's Hospital, Xinghua 225700, Jiangsu Province, China

Yi Yang, Department of Anesthesiology, Suzhou High-Tech Zone People's Hospital, Suzhou 215011, Jiangsu Province, China

Jie Li, Naval Medical Center, Naval Medical University, PLA, Shanghai 200433, China

Lu Zou, Department of Anesthesiology, Changzhou Hospital of Traditional Chinese Medicine, Changzhou 213000, Jiangsu Province, China

Author contributions: Wang Y and Yang Y have the same contribution to this article and should be regarded as the co-first author; Wang Y, Yang Y and Wang DM design the experiment; Li J drafted the work, Bao QT, Wang BB and Zhu SJ collected the data; Yang Y, Zou L and Wang Y analysed and interpreted data, Wang Y, Yang Y, Wang DM and Li J wrote the article.

Institutional review board statement: This study was approved by the Medical Ethics Committee of Xinghua City People's Hospital.

Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.

Conflict-of-interest statement: The authors declared that there is no conflict of interest between them.

Data sharing statement: No additional data are available.

Corresponding author: Lu Zou, MD, Associate Chief Physician, Chief Doctor, Department of Anesthesiology, Changzhou Hospital of Traditional Chinese Medicine, No. 25 Heping North Road, Tianning District, Changzhou 213000, Jiangsu Province, China. baobao01013812@163.com

Received: June 22, 2022
Peer-review started: June 22, 2022
First decision: July 13, 2022
Revised: July 27, 2022
Accepted: October 20, 2022
Article in press: October 20, 2022
Published online: November 26, 2022
Processing time: 154 Days and 1.2 Hours

ARTICLE HIGHLIGHTS

Research background

Mechanical ventilation can lead to the severe impairment of the metabolic pathway of alveolar surfactants, inactivating alveolar surfactants and significantly reducing lung-chest compliance. The cardiopulmonary function of elderly patients usually reduced to a certain extent, and there are lung complications after surgical anesthesia, just like lung barotrauma caused by mechanical ventilation, atelectasis and postoperative hypoxemia.

Research motivation

This study investigated the effects of different positive end expiratory pressures (PEEPs) and tidal volumes (VTs) on respiratory function, the degree of the inflammatory response and hemodynamic indexes in patients undergoing surgery under general anesthesia.

Research objectives

This research aimed to explore the effects of different PEEP and VT control on lung protection and inflammatory factors during surgical anesthesia

Research methods

A total of 120 patients undergoing surgery for gastric or colon cancer under general anesthesia in Xinghua People's Hospital from January 2017 to January 2021 were included.

Research results

There were no significant differences in PaCO₂, PaO₂, oxygen or the examined indexes at T0 between group A and group B. The measured PaO₂ value of patients in group A at T3 was higher than that in group B, and the difference was significant. The measured peak airway pressure value of patients in group A at T1 was higher than that in group B, and the difference was significant. The measured dynamic pulmonary compliance value at T1 and T2 was greater than that in group B).

Research conclusions

For patients undergoing surgery for gastric or colon cancer under general anesthesia, the VT (6.0 mL/kg) + PEEP (5.0 cmH₂O) regimen was more effective than the VT (6.0 mL/kg) + PEEP (8.0 cmH₂O) regimen in protecting the lung function and ventilatory function of patients, and it had better effects on maintaining hemodynamic stability and reducing inflammatory reactions.

Research perspectives

For patients undergoing gastric or colon cancer surgery under general anesthesia, the VT (6.0 mL/kg) + PEEP (5.0 cmH₂O) regimen is more valuable in clinical promotion than the VT (6.0 mL/kg) + PEEP (8.0 cmH₂O) regimen.