engleski

Protective Mechanical Ventilation for the Prevention of Postoperative Pulmonary Complications in ICU patients without the ARDS

Postoperative pulmonary complications are associated with increased morbidity, lenght of hospital stay, and mortality after major surgery. Protective ventilation is strongly recommended in international guidelines for Intensive Care Unit (ICU) patients with the Acute Respiratory Distress Syndrome (ARDS). Recent randomized controlled trials also show that the use of lower tidal volumes is the most important determinant of protection in intraoperative mechanical ventilation of nonobese patient. Guidelines do not yet recommend on tidal volume size in ICU patients without ARDS. Aim of our study was to determine practice of ventilation, impact of tidal volume size and outcomes in ventilated ICU patients without ARDS. We performed a 7-day observational study on 30 intubated and ventilated adult ICU patients who were divided according to the tidal volume size in two groups. Group 1 (n=19) was ventilated with lower (Vt 6-8 ml/ kg) and group 2 (n=11) with higher tidal volume size (Vt > 8 ml/kg). Ventilation parameters were measured once a day. Postoperative pulmonary and extrapulmonary complications, lenght of ICU and hospital stay, mechanical ventilation days and mortality in 90 days period were also recorded. There were no statistically significant differences among the 2 groups with regard to age, gender, BMI, type of operation, and ventilation parameters. Patients ventilated with lower Vt (group 1) had statistically signifficant decrease of postoperative pulmonary complications ( p=0, 027) and mortality ( p=0, 029). According to the recent literature protective ventilation with lower tidal volume is associated with a better clinical results among adult ICU patients without ARDS.

Mechanical ventilation, ARDS, Positive end expiratory pressure

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