Christian Zanza*, Yaroslava Longhitano, Mirco Leo, Tatsiana Romenskaya, Francesco Franceschi, Andrea Piccioni, Ingrid Marcela Pabon, Maria Teresa Santarelli and Fabrizio Racca Pages 1 - 14 ( 14 )
Background: During general anesthesia, mechanical ventilation can cause pulmonary damage through mechanism of ventilator-induced lung injury, which is a major cause of post-operative pulmonary complications, which varies between 5 and 33% and increases the 30-day mortality of the surgical patient significantly. <p> Objective: The aim of this review is to analyze different variables which played a key role in the safe application of mechanical ventilation in the operating room and emergency setting. <p> Methods: Also, we wanted to analyze different types of the population that underwent intraoperative mechanical ventilation like obese patients, pediatric and adult population and different strategies such as one lung ventilation and ventilation in trendelemburg position. The peer-reviewed articles analyzed were selected according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) from Pubmed/Medline, Ovid/Wiley and Cochrane Library, combining key terms such as: “pulmonary post-operative complications”, “protective ventilation”, “alveolar recruitment maneuvers”, “respiratory compliance”, “intraoperative paediatric ventilation”, “best peep”, “types of ventilation”. Among the 230 papers identified, 150 articles were selected, after title - abstract examination and removing the duplicates, resulting in 94 articles related to mechanical ventilation in operating room and emergency setting that were analyzed. <p> Results: Careful preoperative patient’s evaluation and protective ventilation (i.e., use of low tidal volumes, adequate PEEP and alveolar recruitment maneuvers) has been shown to be effective not only in limiting alveolar de-recruitment, alveolar overdistension and lung damage, but also in reducing the onset of Pulmonary Post-operative Complications (PPCs). <p> Conclusion: Mechanical ventilation is like “Janus Bi-front” because it is essential for surgical procedures, for the care of critical care patients and in life-threatening conditions, but it can be harmful to the patient if continued for a long time and where an excessive dose of oxygen is administered into the lungs. Low tidal volume is associated with a minor rate of PPCs and other complications and every complication can increase the length of Stay, adding cost to NHS between 1580 € and 1650 € per day in Europe and currently the prevention of PPCS is the only weapon that we possess.
Pulmonary post-operative complications, protective ventilation, alveolar recruitment maneuvers, respiratory compliance, intraoperative pediatric ventilation, best peep, types of ventilation.
Foundation “Nuovo Ospedale Alba-Bra ONLUS” - Verduno, Foundation “Nuovo Ospedale Alba-Bra ONLUS” - Verduno, Department of Anesthesiology and Critical Care Medicine – AON SS Antonio e Biagio e Cesare Arrigo -Alessandria, Department of Anesthesiology and Critical Care Medicine – AON SS Antonio e Biagio e Cesare Arrigo -Alessandria, Department of Emergency Medicine – Fondazione Policlinico A.Gemelli/Catholic University of Sacred Heart-Rome, Department of Emergency Medicine – Fondazione Policlinico A.Gemelli/Catholic University of Sacred Heart-Rome, Department of Emergency Medicine, Anesthesia and Critical Care Medicine- Michele and Pietro Ferrero Hospital- Verduno, Department of Sensory Organs – Sapienza University of Rome, Department of Anesthesiology and Critical Care Medicine – AON SS Antonio e Biagio e Cesare Arrigo -Alessandria