Anesthesia Experts

Protective Ventilation during Anesthesia: Is It Meaningful?

by Leave a Comment

Authors: Göran Hedenstierna, M.D., Ph.D. et al

Anesthesiology 12/ 2016, Vol.125, 1079-1082.

SEVERAL clinical trials on protective ventilation during anesthesia and postoperative pulmonary complications have been performed during the past years and assumed to be suitable as guidelines for clinical treatment.1–8  Comprehensive reviews and meta-analysis have also been performed.9,10  Why then do these studies differ in their recommendations? One reason may be that the three major tools that have been used for creating protective ventilation have been taken over from intensive care and thus from a different category of patients with severely sick lungs that may be more vulnerable to forces caused by mechanical ventilation. These tools are (1) a low tidal volume or low driving pressure, assumed to reduce stress and strain of the lung; (2) a recruitment maneuver, assumed to reopen any collapsed alveoli; and (3) a positive end-expiratory pressure (PEEP), assumed to keep the lung open during ongoing anesthesia and surgery. Protective ventilation covers a period from induction to emergence from anesthesia, and whether any positive effects remain in the postoperative period is unknown. The atelectasis that develops intraoperatively may last for some days after surgery11  and may be a cause of postoperative pulmonary complications. Without knowing how successful the protective ventilation during anesthesia is in keeping the lung open without excessive strain, and if any positive effects remain in the postoperative period, reduction in postoperative pulmonary complications can hardly be attributed to protective ventilation. One may even ask if the concept protective ventilation can be replaced by nonharmful ventilation during anesthesia. It must also be realized that postoperative lung complications may be related to events other than intraoperative pulmonary dysfunction. That mentioned, let us return to the three tools that make up the framework of protective ventilation and discuss if the physiology makes sense.

 

Leave a Reply

Call (660) 596-2224
What people thought about us

Testimonials

“As Director of Surgical Services Departments there has been considerable changes have occurred in my department and Anesthesia Experts has always risen to meet our demands of our facility. They have been very pro-active in meeting the increase volumes allowing us to keep our surgeons and patients very satisfied with our services.”

AR BSN 346 beds AL   

“Before AE took over the anesthesia department was described by the surgeons as the worst in the history of our hospital. The prior management company was having a cancelled surgery per day. I am happy to report there has not been one since they have taken over the department. Additionally we have seen a 905 reduction if requested preop
lab tests. The anesthesia department is now the very best hospital department in our entire facility.”

DS CEO 272 beds MS   

“Anesthesia Experts has provided consistent anesthesia providers who display a high degree of integrity, responsibility and professionalism. They have become a more valuable part of our facility and community.”

LR CEO 150 beds TX   

“Even though they are physically located 1000 miles away Anesthesia Experts just does not provide great anesthesia coverage they personally engage surgeons to increase their business. Last year my surgical volume rose by 24% and we are currently 50% ahead of last year and all of that growth is organic.”

JE FACHE CEO AL 92 bed hospital   

“Anesthesia Experts is more responsive than anyone I have dealt with. They are available by phone whenever needed and will be on site for any need or request and has been on site to address issues before we can make the request.”

SW CEO 25 beds NM   

“While problems are extremely rare when they do occur Anesthesia Experts quickly and professionally implements a solution. Our surgical volume has grown over 100 cases per month and now our GI docs want to perform all of their endoscopies in our hospital instead of their GI lab that they own!”

SP CEO 346 beds AL   

“Our anesthesia department was a thorn in my side that kept me awake at night. Anesthesia Experts swept in and brought order to our mess and our department was quickly redirected.”

JAM CNO AL 89 bed hospital   

Add a Testimonial

Verification Captcha