Κατεύθυνση Αναπνευστική Ανεπάρκεια-Μηχανικός Αερισμός
Library of the School of Health Sciences

2022-07-12

2022

Tyrovola Nikoletta

Νικολέττα Ροβίνα, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Αντωνία Κουτσούκου, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ιωάννης Βασιλειάδης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ

Διεγχειρητική αντιμετώπιση και προστατευτικός αερισμός σε παχύσαρκους χειρουργικούς ασθενείς: συστηματική ανασκόπηση

Greek

Perioperative management and ventilation strategies in obese patients undergoing surgery; a systematic review.

Introduction: Pathophysiological changes due to morbid obesity may complicate mechanical ventilation during general anesthesia.

Aim: Our aim is to summarize the current evidence for perioperative ventilation strategies in obese surgical patients. The ideal ventilation strategy is expected to optimize gas exchange and pulmonary mechanics and to reduce the risk of respiratory complications.

Material and Method: Systematic search was performed through the MEDLINE, Embase and Cochrane (Central) database aiming for randomized trials testing intraoperative ventilation strategies in obese patients (BMI ≥30 kg/m2).

Results: Thirteen studies reported on a variety of ventilation strategies: pressure- or volume-controlled ventilation (PCV, VCV), various tidal volumes, and different PEEP or recruitment manoeuvres (RM), and combinations thereof. Definitions and reporting of endpoints were inconsistent. In five trials RM added to PEEP compared with PEEP alone improved intraoperative PaO2/FIO2 ratio and increased respiratory system compliance. Arterial pressure remained unchanged. In four trials comparing PCV with VCV, there was no difference in PaO2/FIO2 ratio, tidal volume, or arterial pressure. Comparison of further ventilation strategies or combination of other outcomes was not feasible. Data on postoperative complications were seldom reported.

Conclusion: The ideal intraoperative ventilation strategy in obese patients remains obscure. There is some evidence that RM added to PEEP compared with PEEP alone improves intraoperative oxygenation and compliance without adverse effects. There is no evidence of any difference between PCV and VCV.

Health Sciences

Obesity, Morbid obesity, Anesthesia, Mechanical ventilation, Lung protective ventilation, PEEP, Recruitment maneuver, Postoperative pulmonary complications.

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https://pergamos.lib.uoa.gr/uoa/dl/object/3223976