Open lung approach versus standard protective strategies: Effects on driving pressure and ventilatory efficiency during anesthesia - A pilot, randomized controlled trial

• DOI: 10.1371/journal.pone.0177399
• Publication Date: 2017-05-11T18:44:40Z
• Authors: Carlos Ferrando; Fernando Suarez-S...; Gerardo Tusman; Irene León; Esther Romero; Estefania Gracia; Ana Mugarra; Blanca Arocas; Natividad Pozo; Marina Soro; Francisco J. Belda
• Keywords: Pulmonary compliance; Respiratory physiology; Positive End-Expiratory Pressure

Background Low tidal volume (VT) during anesthesia minimizes lung injury but may be associated to a decrease in functional impairing mechanics and efficiency. Lung recruitment (RM) can restore this critically depend on the post-RM selected PEEP. This study was randomized, two parallel arm, open whose primary outcome compare effects driving pressure of adding RM low-VT ventilation, with or without an individualized PEEP patients known previous disease anesthesia. Methods Consecutive scheduled for major abdominal surgery were submitted ventilation (6 ml·kg-1) standard 5 cmH2O (pre-RM, n = 36). After 30 min estabilization all received randomly allocated either continue same (RM-5 group, 18) open-lung (OL-PEEP) (Open Approach, OLA defined as level resulting maximal Cdyn decremental trial. We compared efficiency measured by volumetric capnography. Results OL-PEEP found at 8±2 cmH2O. 36 included final analysis. When pre-RM, resulted 22% increase compliance 28% when pre-RM. These parameters did not improve RM-5. The trend DP significantly different between RM-5 groups (p 0.002). VDalv/VTalv lower group after 0.035). Conclusions applied improves only strategy diseases undergoing surgery. Trial registration ClinicalTrials.gov NCT02798133