Effect of Individualized Positive End-Expiratory Pressure on Elderly Patients Undergoing Spinal Surgery
Objective To investigate the effect of driving pressure(DP)-guided individualized positive end-expiratory pressure(PEEP)titration on elderly patients undergoing spinal surgery.Methods A total of 137 elderly patients who were scheduled for spinal surgery in prone position under general anesthesia in the Affiliated Sport Hospital of Chengdu Sport University between October 2022 and October 2023 were selected as the study objects.The patients were randomly divided into a titrated PEEP group[tidal volume(VT)=6 mL/kg,titrated PEEP by DP,with intraoperative pulmonary resuscitation,n=46],a fixed PEEP group(VT=6 mL/kg,PEEP=5 cmH2O,with intraoperative pulmonary resuscitation,n=45)and a conventional ventilation group(VT=8 mL/kg,no PEEP,no pulmonary resuscitation,n=46)by random number table method.Hemodynamic indices on admission to the operating room(T0),5 min after tracheal intubation(T1),5 min after position placement(T2),1 h after the begining of surgery(T3),before extubation(T4)and exit from the operating room(T5)were compared.Respiratory mechanics indicators at T1,T2,T3 and T4 were compared.Blood gas analysis indicators at T0,T3 and T4 were compared.Inflammatory factor indicators at T0,1 d after surgery(T6),and before discharge(T7)were compared.The incidence and severity of postoperative pulmonary complications(PPCs)30 d after surgery were compared.The length of stay and total hospital costs were compared.Results A total of 22 patients suffered from PPCs were included,including 6 patients in the PEEP titrated group,5 patients in the fixed PEEP group and 11 patients in the conventional ventilation group.There was no significant difference in the incidence and severity of PPCs,and total hospital costs among the three groups(P＞0.05).The PEEP levels at T2 and T4 in the titrated PEEP group were lower than that at T1(P＜0.05).Compared with the conventional ventilation group,the titrated and fixed PEEP groups had lower DP at T1,T2,T3 and T4,higher arterial partial pressure of carbon dioxid(PaCO2)at T3 and T4,and higher oxygenation index(PaO2/FiO2)at T4(P＜0.05).Compared with the conventional ventilation group,the titrated PEEP group had lower C-reactive protein at T6,and shorter length of stay(P＜0.05).Conclusion An individualized PEEP ventilation strategy during spinal surgery in elderly patients can effectively reduce DP,mitigate inflammation,and enhance oxygenation;however,its impact on postoperative pulmonary complications is not statistically significant.
Degenerative lesion of the spineSpinal surgeryLung protective ventilationPostoperative pulmonary complicationDriving pressureProne position ventilation
万方数据
维普
