| Objective We conducted the trial to determine whether lung protective ventilation that combined low tidal volumes,PEEP could improve outcomes of elderly patients with pulmonary dysfunction after gastrointestinal surgery,as compared with the standard practice of conventional mechanical ventilation.Methods In this trial,we randomly assigned patients with pulmonary dysfunction to either conventional mechanical ventilation or lung-protective ventilation.80 patients(age ≥50 yr,ASA Ⅱ-Ⅲ,NYHA cardiac function Ⅱ-Ⅲ,duration of surgery 2-4 h)were ventilated with:(P)lung protective ventilation [6 ml kg-1 predicted body weight(PBW)] or(C)conventional mechanical ventilation(6 ml kg-1PBW)tidal volumes and P(6cm H2O)or C(0 cm H2O)end-expiratory positive pressure intraoperatively.Respiratory rate was adjusted to maintain PETCO2=35-45 mm Hg.Multi-mode anesthetic management was performed.The primary outcome was major pulmonary complications occurring within the 30 days after surgery.The secondary outcomes were blood gas,score of CPIS,spontaneous breathing recovery time,,drawing tube time,PACU time,gastrointestinal function recovery time,ambulation time,hospital stay,cost of hospitalization and extrapulmonary complications.Results The two groups had similar characteristics at baseline.Pa O2 of C was decreased 1 and 3 days after surgery(P<0.05).Pa CO2 of P was lower 1 and 3 days after surgery compare with C(P<0.05).The duration of PACU stay in group P was shortened compared with C group(P<0.05).A composite of major pulmonary and extrapulmonary complications occurring within the 30-day postoperative period was less among patients receiving lung-protective ventilation than among ose receiving conventional ventilation.Conclusion Under the condition of this research,lung protective ventilation may improve elderly patients with poor pulmonary function after gastrointestinal surgery,improve postoperative oxygen and help to reduce the occurrence of postoperative complications. |
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