Neuschwander Arthur, Futier Emmanuel, Jaber Samir, Pereira Bruno, Eurin Mathilde, Marret Emmanuel, Szymkewicz Olga, Beaussier Marc, Paugam-Burtz Catherine
From the Department of Intensive Care and Anesthesiology, AP-HP, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Paris (AN, ME, CPB); Department of Anesthesiology and Critical Care Medicine, Estaing Hospital, University Teaching Hospital of Clermont-Ferrand, and R2D2 unit, EA 7281, Clermont-Ferrand (EF); Department of Anesthesiology and Critical Care Medicine, Hôpital Saint-Eloi, University Teaching Hospital of Montpellier and INSERM U-1046, Montpellier (SJ); University Hospital of Clermont-Ferrand, Biostatistics Unit (DRCI), Clermont-Ferrand (BP); Department of Anesthesiology and Critical care Medicine, Hôpital Tenon, AP-HP (EM, OS); Department of Anesthesiology and Critical care Medicine, Hôpital Saint Antoine, AP-HP, Université Pierre et Marie Curie PARIS VI (MB); University Paris Diderot, Sorbonne Paris Cité (CPB); and INSERM U773, CRB3, Paris, France (CPB).
Eur J Anaesthesiol. 2016 Apr;33(4):292-8. doi: 10.1097/EJA.0000000000000390.
During high-risk abdominal surgery the use of a multi-faceted lung protective ventilation strategy composed of low tidal volumes, positive end-expiratory pressure (PEEP) and recruitment manoeuvres, has been shown to improve clinical outcomes. It has been speculated, however, that mechanical ventilation using PEEP might increase intraoperative bleeding during liver resection.
To study the impact of mechanical ventilation with PEEP on bleeding during hepatectomy.
Post-hoc analysis of a randomised controlled trial.
Seven French university teaching hospitals from January 2011 to August 2012.
Patients scheduled for liver resection surgery.
In the Intraoperative Protective Ventilation trial, patients scheduled for major abdominal surgery were randomly assigned to mechanical ventilation using low tidal volume, PEEP between 6 and 8 cmH2O and recruitment manoeuvres (lung protective ventilation strategy) or higher tidal volume, zero PEEP and no recruitment manoeuvres (non-protective ventilation strategy).
The primary endpoint was intraoperative blood loss volume.
A total of 79 (19.8%) patients underwent liver resections (41 in the lung protective and 38 in the non-protective group). The median (interquartile range) amount of intraoperative blood loss was 500 (200 to 800) ml and 275 (125 to 800) ml in the non-protective and lung protective ventilation groups, respectively (P = 0.47). Fourteen (35.0%) and eight (21.5%) patients were transfused in the non-protective and lung protective groups, respectively (P = 0.17), without a statistically significant difference in the median (interquartile range) number of red blood cells units transfused [2.5 (2 to 4) units and 3 (2 to 6) units in the two groups, respectively; P = 0.54].
During hepatic surgery, mechanical ventilation using PEEP within a multi-faceted lung protective strategy was not associated with increased bleeding compared with non-protective ventilation using zero PEEP.
The current study was not registered. The original Intraoperative Protective Ventilation study was registered on clinicaltrials.gov; number NCT01282996.
在高风险腹部手术中，采用由低潮气量、呼气末正压（PEEP）和肺复张手法组成的多方面肺保护通气策略已被证明可改善临床结局。然而，有人推测，使用PEEP进行机械通气可能会增加肝切除术中的出血。
研究使用PEEP进行机械通气对肝切除术中出血的影响。
一项随机对照试验的事后分析。
2011年1月至2012年8月期间的7家法国大学教学医院。
计划进行肝切除手术的患者。
在术中保护性通气试验中，计划进行大型腹部手术的患者被随机分配接受低潮气量、6至8厘米水柱的PEEP和肺复张手法的机械通气（肺保护通气策略）或较高潮气量、零PEEP且无肺复张手法的机械通气（非保护通气策略）。
主要终点是术中失血量。
共有79名（19.8%）患者接受了肝切除术（肺保护组41名，非保护组38名）。非保护通气组和肺保护通气组的术中失血量中位数（四分位间距）分别为500（200至800）毫升和275（125至800）毫升（P = 0.47）。非保护组和肺保护组分别有14名（35.0%）和8名（21.5%）患者接受了输血（P = 0.17），两组输注红细胞单位的中位数（四分位间距）无统计学显著差异[两组分别为2.5（2至4）单位和3（2至6）单位；P = 0.54]。
在肝脏手术中，与使用零PEEP的非保护通气相比，在多方面肺保护策略中使用PEEP进行机械通气与出血增加无关。
本研究未注册。最初的术中保护性通气研究已在clinicaltrials.gov上注册；编号为NCT01282996。
