Title:Practical Review of Mechanical Ventilation in Adults and Children in the
Operating Room and Emergency Department
Volume: 17
Issue: 1
Author(s): Christian Zanza*, Yaroslava Longhitano, Mirco Leo, Tatsiana Romenskaya, Francesco Franceschi, Andrea Piccioni, Ingrid M. Pabon, Maria T. Santarelli and Fabrizio Racca
Affiliation:
- Foundation “Ospedale Alba-Bra ONLUS” - Verduno-Italy-Europe
- Department of Anesthesiology and Critical Care
Medicine - AON SS Antonio e Biagio e Cesare Arrigo -Alessandria-Italy-Europe
- Department of Emergency
Medicine, Anesthesia and Critical Care Medicine- Michele and Pietro Ferrero Hospital- Verduno-Italy-Europe
- Department
of Emergency Medicine - Fondazione Policlinico A.Gemelli/Catholic University of Sacred Heart-Rome-Italy
Keywords:
Pulmonary post-operative complications, protective ventilation, alveolar recruitment maneuvers, respiratory compliance, intraoperative pediatric ventilation, best peep, types of ventilation.
Abstract:
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.
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.
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.
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).
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.
