Open AccessEvaluation of the influence of individualized protective ventilation on the lung mechanical properties
Author(s) -
T. S. Kuzmenko,
С. И. Воротынцев
Publication year - 2021
Publication title -
medicina neotložnyh sostoânij
Language(s) - English
Resource type - Journals
eISSN - 2307-1230
pISSN - 2224-0586
DOI - 10.22141/2224-0586.17.6.2021.242329
Subject(s) - medicine , exhalation , pulmonary compliance , ventilation (architecture) , mechanical ventilation , respiratory physiology , hypoxemia , anesthesia , compliance (psychology) , tidal volume , lung , intensive care medicine , respiratory system , engineering , mechanical engineering , social psychology , psychology
The work is devoted to the study of the influence of individualized protective ventilation support on pulmonary mecha-nics. The study included 47 patients who underwent open abdominal surgery under general anesthesia. All patients had a moderate to high risk of developing postoperative pulmonary complications by the ARISCAT scale. Intraoperatively, the impact of individualized protective ventilation on respiratory mechanics, namely Ppeak, Pplat, Pdrive, dynamic pulmonary compliance was assessed. Individualized protective respiratory support was ventilation with a tidal volume of 7 ml/kg of ideal body weight, with the selection of the optimal level of positive pressure at the end of exhalation (PEEP), focusing on dynamic pulmonary compliance and performing recruiting maneuver, and then in the case of a decrease in dynamic pulmonary compliance by more than 20 %, followed by re-selection of PEEP. The studied parameters were recorded before and after the recruiting maneuver, as well as on the 30th, 60th, 90th, 120th, 150th, 180th minutes after the recruiting maneuver, depending on the duration of the operation. The use of alveolar straightening techniques led to an improvement in pulmonary mechanics, namely, an increase in dynamic pulmonary compliance by 16 % and a decrease in Pdrive by 17 %. The intraoperative level of PEEP averaged 4 [4; 5] cm of water. No cases of hypoxemia or recurrence of recruiting maneuver were reported. The obtained results indicate that chosen technique of recruiting maneuver is effective and safe, and its use allows reducing the negative impact of mechanical ventilation. The study did not find a statistically significant correlation between the level of PEEP and the value of dynamic pulmonary compliance. Such data prove the need for individual selection of ventilation parameters according to the characteristics of the mechanical properties of each patient.