The Effect of Mechanical Ventilation With Low Tidal Volume on Blood Loss During Laparoscopic Liver Resection: A Randomized Controlled Trial.

Szczegóły
Abstrakt

Tytuł:: The Effect of Mechanical Ventilation With Low Tidal Volume on Blood Loss During Laparoscopic Liver Resection: A Randomized Controlled Trial.
Autorzy:: Gao X; From the Department of Anesthesiology.
Xiong Y; From the Department of Anesthesiology.
Huang J; From the Department of Anesthesiology.
Zhang N; From the Department of Anesthesiology.
Li J; Department of Hepatology, Southwest Hospital, Third Military Medical University, Chongqing, China.
Zheng S; Department of Hepatology, Southwest Hospital, Third Military Medical University, Chongqing, China.
Lu K; From the Department of Anesthesiology.
Ma D; Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom.
Yang B; Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China.
Ning J; From the Department of Anesthesiology.
Źródło:: Anesthesia and analgesia [Anesth Analg] 2021 Apr 01; Vol. 132 (4), pp. 1033-1041.
Typ publikacji:: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
Język:: English
Imprint Name(s):: Publication: 1998- : Baltimore, Md. : Lippincott Williams & Wilkins
Original Publication: Cleveland, International Anesthesia Research Society.
MeSH Terms:: Hepatectomy*/adverse effects
Laparoscopy*/adverse effects
Respiration, Artificial*/adverse effects
Tidal Volume*
Blood Loss, Surgical/*prevention & control
Adult ; Blood Transfusion ; China ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Risk Assessment ; Risk Factors ; Single-Blind Method ; Time Factors ; Treatment Outcome
References:: Elshamy M, Takahashi H, Akyuz M, et al. Evolution of a laparoscopic liver resection program: an analysis of 203 cases. Surg Endosc. 2017;31:4150–4155.
Kawaguchi Y, Nomi T, Fuks D, Mal F, Kokudo N, Gayet B. Hemorrhage control for laparoscopic hepatectomy: technical details and predictive factors for intraoperative blood loss. Surg Endosc. 2016;30:2543–2551.
Katz SC, Shia J, Liau KH, et al. Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg. 2009;249:617–623.
Jarnagin WR, Gonen M, Fong Y, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002;236:397–406.
Maurizio B, Fabio P, Rocco B, et al. Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann Surg. 2003;237:860–869.
Fan ST, Mau Lo C, Poon RT, et al. Continuous improvement of survival outcomes of resection of hepatocellular carcinoma: a 20-year experience. Ann Surg. 2011;253:745–758.
Yeh CN, Chen MF, Lee WC, Jeng LB. Prognostic factors of hepatic resection for hepatocellular carcinoma with cirrhosis: univariate and multivariate analysis. J Surg Oncol. 2002;81:195–202.
Sitzmann JV, Greene PS. Perioperative predictors of morbidity following hepatic resection for neoplasm. A multivariate analysis of a single surgeon experience with 105 patients. Ann Surg. 1994;219:13–17.
Shimada M, Takenaka K, Fujiwara Y, et al. Risk factors linked to postoperative morbidity in patients with hepatocellular carcinoma. Br J Surg. 1998;85:195–198.
Ibrahim S, Chen CL, Lin CC, et al. Intraoperative blood loss is a risk factor for complications in donors after living donor hepatectomy. Liver Transpl. 2006;12:950–957.
Smyrniotis V, Kostopanagiotou G, Theodoraki K, Tsantoulas D, Contis JC. The role of central venous pressure and type of vascular control in blood loss during major liver resections. Am J Surg. 2004;187:398–402.
Otsubo T. Control of the inflow and outflow system during liver resection. J Hepatobiliary Pancreat Sci. 2012;19:15–18.
Huntington JT, Royall NA, Schmidt CR. Minimizing blood loss during hepatectomy: a literature review. J Surg Oncol. 2014;109:81–88.
Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection. Br J Surg. 1998;85:1058–1060.
Hughes MJ, Ventham NT, Harrison EM, Wigmore SJ. Central venous pressure and liver resection: a systematic review and meta analysis. HPB (Oxford). 2015;17:863–871.
Wakabayashi G, Cherqui D, Geller DA, et al. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg. 2015;261:619–629.
Halls MC, Cipriani F, Berardi G, et al. Conversion for unfavorable intraoperative events results in significantly worse outcomes during laparoscopic liver resection: lessons learned from a multicenter review of 2861 cases. Ann Surg. 2018;268:1051–1057.
Iguchi T, Ikegami T, Fujiyoshi T, Yoshizumi T, Shirabe K, Maehara Y. Low positive airway pressure without positive end-expiratory pressure decreases blood loss during hepatectomy in living liver donors. Dig Surg. 2017;34:192–196.
Neuschwander A, Futier E, Jaber S, et al. The effects of intraoperative lung protective ventilation with positive end-expiratory pressure on blood loss during hepatic resection surgery: a secondary analysis of data from a published randomised control trial (IMPROVE). Eur J Anaesthesiol. 2016;33:292–298.
Nguyen NT, Anderson JT, Budd M, et al. Effects of pneumoperitoneum on intraoperative pulmonary mechanics and gas exchange during laparoscopic gastric bypass. Surg Endosc. 2004;18:64–71.
Jayaraman S, Khakhar A, Yang H, Bainbridge D, Quan D. The association between central venous pressure, pneumoperitoneum, and venous carbon dioxide embolism in laparoscopic hepatectomy. Surg Endosc. 2009;23:2369–2373.
Yang D, Dalton JE. A unified approach to measuring the effect size between two groups using SAS. 2012. Proceedings of SAS Global Forum Conference. Paper 335-2012.
Poon RT. Current techniques of liver transection. HPB Surg. 2007;9:166–173.
Kobayashi S, Honda G, Kurata M, et al. An experimental study on the relationship among airway pressure, pneumoperitoneum pressure, and central venous pressure in pure laparoscopic hepatectomy. Ann Surg. 2016;263:1159–1163.
Dunki-Jacobs EM, Philips P, Scoggins CR, McMasters KM, Martin RC II. Stroke volume variation in hepatic resection: a replacement for standard central venous pressure monitoring. Ann Surg Oncol. 2014;21:473–478.
Ratti F, Cipriani F, Reineke R, et al. Intraoperative monitoring of stroke volume variation versus central venous pressure in laparoscopic liver surgery: a randomized prospective comparative trial. HPB (Oxford). 2016;18:136–144.
Su BC, Tsai YF, Cheng CW, et al. Stroke volume variation derived by arterial pulse contour analysis is a good indicator for preload estimation during liver transplantation. Transplant Proc. 2012;44:429–432.
Futier E, Constantin JM, Paugam-Burtz C, et al.; IMPROVE Study Group. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med. 2013;369:428–437.
Rackley CR, MacIntyre NR. Low tidal volumes for everyone? Chest. 2019;156:783–791.
Lansdorp B, Hofhuizen C, van Lavieren M, et al. Mechanical ventilation-induced intrathoracic pressure distribution and heart-lung interactions*. Crit Care Med. 2014;42:1983–1990.
Tranchart H, Di Giuro G, Lainas P, et al. Laparoscopic liver resection with selective prior vascular control. Am J Surg. 2013;205:8–14.
Eiriksson K, Fors D, Rubertsson S, Arvidsson D. High intra-abdominal pressure during experimental laparoscopic liver resection reduces bleeding but increases the risk of gas embolism. Br J Surg. 2011;98:845–852.
Molecular Sequence:: ChiCTR ChiCTR-IPR-17011064
Entry Date(s):: Date Created: 20201016 Date Completed: 20210405 Latest Revision: 20210405
Update Code:: 20240105
DOI:: 10.1213/ANE.0000000000005242
PMID:: 33060490
: Czasopismo naukowe

Background: Control of bleeding during laparoscopic liver resection (LLR) is important for patient safety. It remains unknown what the effects of mechanical ventilation with varying tidal volumes on bleeding during LLR. Thus, this study aims to investigate whether mechanical ventilation with low tidal volume (LTV) reduces surgical bleeding during LLR.
Methods: In this prospective, randomized, and controlled clinical study, 82 patients who underwent scheduled LLR were enrolled and randomly received either mechanical ventilation with LTV group (6-8 mL/kg) along with recruitment maneuver (once/30 min) without positive end-expiratory pressure (PEEP) or conventional tidal volume (CTV; 10-12 mL/kg) during parenchymal resection. The estimated volume of blood loss during parenchymal resection and the incidence of postoperative respiratory complications were compared between 2 groups.
Result: The estimated volume of blood loss (median [interquartile range {IQR}]) was decreased in the LTV group compared to the CTV group (301 [148, 402] vs 394 [244, 672] mL, P = .009); blood loss per cm2 of transected surface of liver (5.5 [4.1, 7.7] vs 12.2 [9.8, 14.4] mL/cm2, P < .001) and the risk of clinically significant estimated blood loss (>800 mL) were reduced in the LTV group compared to the CTV group (0/40 vs 8/40, P = .003). Blood transfusion was decreased in the LTV group compared to the CTV group (5% vs 20% of patients, P = .043). No patient in the LTV group but 2 patients in the CTV group were switched from LLR to open hepatectomy. Airway plateau pressure was lower in the LTV group compared to the CTV group (mean ± standard deviation [SD]) (12.7 ± 2.4 vs 17.5 ± 3.5 cm H2O, P = .002).
Conclusions: Mechanical ventilation with LTV may reduce bleeding during laparoscopic liver surgery.
Competing Interests: The authors declare no conflicts of interest.
(Copyright © 2021 International Anesthesia Research Society.)

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