Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
the Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Anesthesiology. 2021 Dec 1;135(6):1004-1014. doi: 10.1097/ALN.0000000000003997.
Despite previous reports suggesting that pressure support ventilation facilitates weaning from mechanical ventilation in the intensive care unit, few studies have assessed its effects on recovery from anesthesia. The authors hypothesized that pressure support ventilation during emergence from anesthesia reduces postoperative atelectasis in patients undergoing laparoscopic surgery using the Trendelenburg position.
In this randomized controlled double-blinded trial, adult patients undergoing laparoscopic colectomy or robot-assisted prostatectomy were assigned to either the pressure support (n = 50) or the control group (n = 50). During emergence (from the end of surgery to extubation), pressure support ventilation was used in the pressure support group versus intermittent manual assistance in the control group. The primary outcome was the incidence of atelectasis diagnosed by lung ultrasonography at the postanesthesia care unit (PACU). The secondary outcomes were Pao2 at PACU and oxygen saturation measured by pulse oximetry less than 92% during 48 h postoperatively.
Ninety-seven patients were included in the analysis. The duration of emergence was 9 min and 8 min in the pressure support and control groups, respectively. The incidence of atelectasis at PACU was lower in the pressure support group compared to that in the control group (pressure support vs. control, 16 of 48 [33%] vs. 28 of 49 [57%]; risk ratio, 0.58; 95% CI, 0.35 to 0.91; P = 0.024). In the PACU, Pao2 in the pressure support group was higher than that in the control group (92 ± 26 mmHg vs. 83 ± 13 mmHg; P = 0.034). The incidence of oxygen saturation measured by pulse oximetry less than 92% during 48 h postoperatively was not different between the groups (9 of 48 [19%] vs. 11 of 49 [22%]; P = 0.653). There were no adverse events related to the study protocol.
The incidence of postoperative atelectasis was lower in patients undergoing either laparoscopic colectomy or robot-assisted prostatectomy who received pressure support ventilation during emergence from general anesthesia compared to those receiving intermittent manual assistance.
尽管先前有研究表明压力支持通气有助于 ICU 患者脱机，但很少有研究评估其对麻醉苏醒的影响。作者假设，在接受腹腔镜手术的患者从麻醉中苏醒时使用压力支持通气可以减少术后肺不张。
在这项随机对照双盲试验中，接受腹腔镜结肠切除术或机器人辅助前列腺切除术的成年患者被分为压力支持组（n = 50）和对照组（n = 50）。在苏醒期间（从手术结束到拔管），压力支持组使用压力支持通气，对照组间歇性手动辅助通气。主要结局是术后恢复室（PACU）时通过肺部超声诊断的肺不张发生率。次要结局是 PACU 时的 PaO2 和术后 48 小时内脉搏血氧饱和度低于 92%的发生率。
97 例患者纳入分析。压力支持组和对照组的苏醒时间分别为 9 分钟和 8 分钟。PACU 时，压力支持组的肺不张发生率低于对照组（压力支持组 48 例中有 16 例[33%]，对照组 49 例中有 28 例[57%]；风险比，0.58；95%CI，0.35 至 0.91；P = 0.024）。PACU 时，压力支持组的 PaO2 高于对照组（92 ± 26mmHg 比 83 ± 13mmHg；P = 0.034）。两组术后 48 小时内脉搏血氧饱和度低于 92%的发生率无差异（压力支持组 48 例中有 9 例[19%]，对照组 49 例中有 11 例[22%]；P = 0.653）。无与研究方案相关的不良事件。
与接受间歇性手动辅助通气的患者相比，在全麻苏醒期间接受压力支持通气的腹腔镜结肠切除术或机器人辅助前列腺切除术患者术后肺不张的发生率较低。
