New findings on intraoperative ventilation

Editor's Note

Among patients at increased risk for postoperative pulmonary complications undergoing intraoperative ventilation, using driving pressure–guided high positive end-expiratory pressure (PEEP) and recruitment maneuvers did not reduce postoperative pulmonary complications compared to using standard low PEEP without recruitment maneuvers for patients undergoing open abdominal surgery under general anesthesia.

This is according to clinical trial findings published December 3  in JAMA that compared driving pressure–guided high PEEP and recruitment maneuvers with standard low PEEP without recruitment maneuvers. These intraoperative ventilation methods were compared for effects on postoperative pulmonary complications, including severe respiratory failure, bronchospasm, suspected pulmonary infection, new pulmonary infiltrates, aspiration pneumonitis, new atelectasis, acute respiratory distress syndrome, new pleural effusion, new cardiopulmonary edema, and new pneumothorax.

In this clinical trial, 1435 adult patients were randomized to undergo intraoperative ventilation with driving pressure–guided high PEEP and recruitment maneuvers or intraoperative ventilation with standard low PEEP. All patients received low tidal volume ventilation.

While no significant improvement in postoperative pulmonary complications was identified between the two intraoperative ventilation techniques, the incidence of hypotension and use of vasoactive agents was higher in the high PEEP group, and incidence of intraoperative desaturation was higher in the low PEEP group, per the article. These findings shed further light on previous uncertainty surrounding how these intraoperative ventilation approaches influence clinical outcomes.