THE INFLUENCE OF PROTECTIVE VENTILATION STRATEGY ON THE RATE OF CRITICAL INCIDENTS IN ABDOMINAL SURGERY: THE ROLE OF TOLERANCE TO TRANSIENT HYPOXIA AND HYPERCAPNIA
DOI:
https://doi.org/10.31379/2411.2616.14.2.10Keywords:
protective ventilation, hemodynamic incidents, breath-holding test.Abstract
The aim of the research was to study the effect of the intraoperative ventilation strategy on the rate of critical incidents during major abdominal surgery in patients with different tolerance to transient hypoxia and hypercapnia determined by the duration of the breath-holding test. Methods. The study included 300 patients undergoing major abdominal surgery, all of them were divided into two groups: with a breath-holding duration of 34 seconds or less, (n=150); and a breath-holding duration of more than 34 seconds (n=150). In both groups, patients were randomized into three subgroups: PEEP 5 cm H2O, PEEP 10 cm H2O, and PEEP 10 cm H2O with recruitment maneuver (RM). We evaluated the frequency of critical incidents, oxygenation and the respiratory mechanics g. Results. The rate of hemodynamic incidents was higher in the group with a breathholding duration of 34 seconds or less in all subgroups. The use of RM significantly increased their number compared to PEEP 10 cm H2O. There were no significant differences in the rate of hemodynamic incidents between ventilation strategies in the group of patients with a breath-holding duration of more than 34 seconds. Conclusion. In patients with low tolerance to transient hypoxia and hypercapnia (the duration of the breath-holding test is 34 seconds or less), the use of the lung opening maneuver is associated with the risk of hemodynamic incidents.
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