The Society for Translational Medicine: Clinical practice guidelines for mechanical ventilation management for patients undergoing lobectomy
Journal
Journal of Thoracic Disease
Journal Volume
9
Journal Issue
9
Pages
3246-3254
Date Issued
2017
Author(s)
Gao S.
Zhang Z.
Brunelli A.
Chen C.
Chen C.
Chen G.
Chen H.
Cassivi S.
Chai Y.
Downs J.B.
Fang W.
Fu X.
Garutti M.I.
He J.
He J.
Hu J.
Huang Y.
Jiang G.
Jiang H.
Jiang Z.
Li D.
Li G.
Li H.
Li Q.
Li X.
Li Y.
Li Z.
Liu C.-C.
Liu D.
Liu L.
Liu Y.
Ma H.
Mao W.
Mao Y.
Mou J.
Ng C.S.H.
Petersen R.H.
Qiao G.
Rocco G.
Ruffini E.
Tan L.
Tan Q.
Tong T.
Wang H.
Wang Q.
Wang R.
Wang S.
Xie D.
Xue Q.
Xue T.
Xu L.
Xu S.
Xu S.
Yan T.
Yu F.
Yu Z.
Zhang C.
Zhang L.
Zhang T.
Zhang X.
Zhao X.
Zhao X.
Zhi X.
Zhou Q.
Abstract
Patients undergoing lobectomy are at significantly increased risk of lung injury. One-lung ventilation is the most commonly used technique to maintain ventilation and oxygenation during the operation. It is a challenge to choose an appropriate mechanical ventilation strategy to minimize the lung injury and other adverse clinical outcomes. In order to understand the available evidence, a systematic review was conducted including the following topics: (I) protective ventilation (PV); (II) mode of mechanical ventilation [e.g., volume controlled (VCV) versus pressure controlled (PCV)]; (III) use of therapeutic hypercapnia; (IV) use of alveolar recruitment (open-lung) strategy; (V) pre-and post-operative application of positive end expiratory pressure (PEEP); (VI) Inspired Oxygen concentration; (VII) Non-intubated thoracoscopic lobectomy; and (VIII) adjuvant pharmacologic options. The recommendations of class II are non-intubated thoracoscopic lobectomy may be an alternative to conventional one-lung ventilation in selected patients. The recommendations of class IIa are: (I) Therapeutic hypercapnia to maintain a partial pressure of carbon dioxide at 50-70 mmHg is reasonable for patients undergoing pulmonary lobectomy with one-lung ventilation; (II) PV with a tidal volume of 6 mL/kg and PEEP of 5 cmH2O are reasonable methods, based on current evidence; (III) alveolar recruitment [open lung ventilation (OLV)] may be beneficial in patients undergoing lobectomy with one-lung ventilation; (IV) PCV is recommended over VCV for patients undergoing lung resection; (V) pre- and post-operative CPAP can improve short-term oxygenation in patients undergoing lobectomy with one-lung ventilation; (VI) controlled mechanical ventilation with I:E ratio of 1:1 is reasonable in patients undergoing one-lung ventilation; (VII) use of lowest inspired oxygen concentration to maintain satisfactory arterial oxygen saturation is reasonable based on physiologic principles; (VIII) Adjuvant drugs such as nebulized budesonide, intravenous sivelestat and ulinastatin are reasonable and can be used to attenuate inflammatory response. ? Journal of Thoracic Disease.
SDGs
Other Subjects
budesonide; sivelestat; ulinastatin; adjuvant therapy; arterial oxygen saturation; Article; artificial ventilation; blood carbon dioxide tension; human; hypercapnia; length of stay; lung compliance; lung lobectomy; mortality; noninvasive ventilation; one lung ventilation; oxygen concentration; patient care; positive end expiratory pressure; postoperative period; practice guideline; preoperative period; systematic review; tidal volume; video assisted thoracoscopic surgery
Publisher
AME Publishing Company
Type
journal article