Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, India.
J Perioper Pract. 2023 Apr;33(4):99-106. doi: 10.1177/17504589211045218. Epub 2022 Mar 24.
Postoperative pulmonary complications vary in major upper abdominal surgery. The objective of this study was to assess the effect of positive end expiratory pressure on the incidence of atelectasis in patients undergoing major upper abdominal surgery under general anaesthesia using lung ultrasound. The patients were randomised into receiving either no positive end expiratory pressure (Group I) or positive end expiratory pressure of 5cm HO (Group II). Lung ultrasound was performed at various time points - baseline, 10 minutes, 2 hours after induction, during closure of skin and 30 minutes post extubation. The lung aeration as assessed by Total Modified Lung Ultrasound Score was worse in the Group I as compared to the Group II at 2 hours post induction. Driving pressure in Group II was significantly reduced compared to Group I. Application of positive end expiratory pressure, as minimal as 5cm HO, as a single intervention, helps in significantly reducing the Total Modified Lung Ultrasound Score after a duration of more than 2 hours and also attaining low driving pressures during intraoperative mechanical ventilation.
术后肺部并发症在上腹部大手术后有所不同。本研究的目的是使用肺部超声评估在全身麻醉下接受上腹部大手术的患者中，呼气末正压对肺不张发生率的影响。患者被随机分为两组，一组不接受呼气末正压（I 组），一组接受 5cmH2O 的呼气末正压（II 组）。在基线、诱导后 10 分钟、2 小时、皮肤关闭时和拔管后 30 分钟进行肺部超声检查。与 II 组相比，I 组在诱导后 2 小时时 Total Modified Lung Ultrasound Score 评估的肺充气情况更差。与 I 组相比，II 组的驱动压显著降低。作为单一干预措施，应用最小呼气末正压 5cmH2O 有助于在 2 小时以上的时间内显著降低 Total Modified Lung Ultrasound Score，并在术中机械通气期间达到低驱动压。
