Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Policlinico San Martino, Genova, Italy; Department of Intensive Care, Amsterdam, The Netherlands.
Department of Intensive Care, Amsterdam, The Netherlands; Department of Anaesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Br J Anaesth. 2018 Oct;121(4):899-908. doi: 10.1016/j.bja.2018.04.021. Epub 2018 Jun 2.
There is limited information concerning the current practice of intraoperative mechanical ventilation in obese patients, and the optimal ventilator settings for these patients are debated. We investigated intraoperative ventilation parameters and their associations with the development of postoperative pulmonary complications (PPCs) in obese patients.
We performed a secondary analysis of the international multicentre Local ASsessment of VEntilatory management during General Anesthesia for Surgery' (LAS VEGAS) study, restricted to obese patients, with a predefined composite outcome of PPCs as primary end-point.
We analysed 2012 obese patients from 135 hospitals across 29 countries in Europe, North America, North Africa, and the Middle East. Tidal volume was 8.8 [25-75 percentiles: 7.8-9.9] ml kg predicted body weight, PEEP was 4 [1-5] cm HO, and recruitment manoeuvres were performed in 7.7% of patients. PPCs occurred in 11.7% of patients and were independently associated with age (P<0.001), body mass index ≥40 kg m (P=0.033), obstructive sleep apnoea (P=0.002), duration of anaesthesia (P<0.001), peak airway pressure (P<0.001), use of rescue recruitment manoeuvres (P<0.05) and routine recruitment manoeuvres performed by bag squeezing (P=0.021). PPCs were associated with an increased length of hospital stay (P<0.001).
Obese patients are frequently ventilated with high tidal volume and low PEEP, and seldom receive recruitment manoeuvres. PPCs increase hospital stay, and are associated with preoperative conditions, duration of anaesthesia and intraoperative ventilation settings. Randomised trials are warranted to clarify the role of different ventilatory parameters in obese patients.
NCT01601223.
目前有关肥胖患者术中机械通气的实践信息有限，并且这些患者的最佳呼吸机设置仍存在争议。我们研究了术中通气参数及其与肥胖患者术后肺部并发症（PPCs）发展之间的关联。
我们对国际多中心局部评估通气管理在普通麻醉下手术中的应用（LAS VEGAS）研究进行了二次分析，仅限于肥胖患者，将 PPCs 的复合预定义结局作为主要终点。
我们分析了来自欧洲、北美、北非和中东的 29 个国家/地区的 135 家医院的 2012 例肥胖患者。潮气量为 8.8 [25-75 百分位数：7.8-9.9] ml kg 预测体重，PEEP 为 4 [1-5] cm H2O，7.7%的患者进行了肺复张手法。11.7%的患者发生了 PPCs，与年龄（P<0.001）、体重指数≥40 kg m （P=0.033）、阻塞性睡眠呼吸暂停（P=0.002）、麻醉持续时间（P<0.001）、气道峰压（P<0.001）、使用挽救性肺复张手法（P<0.05）和常规通过挤压气囊进行肺复张手法（P=0.021）有关。PPCs 与住院时间延长有关（P<0.001）。
肥胖患者经常接受高潮气量和低 PEEP 通气，很少进行肺复张手法。PPCs 会增加住院时间，与术前状况、麻醉持续时间和术中通气参数有关。需要进行随机试验以阐明不同通气参数在肥胖患者中的作用。
NCT01601223。
