How To Prevent Ventilator-Related Lung Damage in Intraoperative Mechanical Ventilation? Pcv or Vcv ?
Condition: Ventilator-Induced Lung Injury; Ventilator Lung; Mechanical Ventilation Complication; Postoperative Complications
MeSH terms: Lung Injury; Ventilator-Induced Lung Injury; Postoperative Complications
Study type: Observational [Patient Registry]

Summary: 
      Introduction: Intraoperative Mechanical Ventilation practices can lead to
      ventilator-associated lung injury (VILI) and postoperative pulmonary complications in healthy
      lungs. Mechanical Power has been developed as a new concept in reducing the risk of
      postoperative pulmonary complications as it takes into account all respiratory mechanics that
      cause VILI formation. Volume control mode is at the forefront in the old anesthesia devices
      used in the operating room, and today, together with technology, there are anesthesia devices
      with many modes and features, as in intensive care units. This causes confusion in the use of
      mechanical ventilators. In this study, volume and pressure control ventilation modes were
      compared in terms of respiratory mechanics (including mechanical power) in patients operated
      in the supine and prone positions.

      Aim of study: It has been compared the effects on postoperative pulmonary complications (PPH)
      in terms of VILI risk by calculating mechanical power from advanced respiratory mechanics of
      patients ventilated in pressure and volume control modes, which are frequently used in
      operating room applications.

      Conclusion: There was no statistically significant difference between the groups in terms of
      demographic data, ariscat score, and ariscat risk group values. The supine and prone
      mechanical power (MPrs) values of the volume control group were statistically significantly
      lower than the pressure control group. P values were calculated as 0.012 and 0.001,
      respectively.

      Results: Supine and prone MPrs values of the volume control group were calculated
      significantly lower than the pressure control group. Pressure-controlled intraoperative
      mechanical ventilation is considered to be disadvantageous in terms of the risk of VILI in
      the supine and prone position in terms of the current mechanical power concept.
    

Detailed description: 
      Although mechanical ventilation is a life-saving intervention, it can lead to
      ventilator-induced lung injury (VILI). VILI is the damage caused by positive pressure
      ventilation that starts with the use of mechanical ventilators. There are many factors that
      cause VILI such as tidal volume, drive pressure, flow, respiratory rate, and PEEP. Mechanical
      power, which collects these different variables in a single parameter, offers us new
      possibilities in predicting VILI at the bedside. The mechanical power being above a certain
      threshold causes damage ranging from pulmonary parenchymal rupture to severe inflammation and
      edema. Also, higher mechanical power values are associated with higher mortality. The
      protective ventilation strategy in intensive care units is also applied in operating rooms
      (OR) to minimize the risk of postoperative pulmonary complications due to VILI. While the
      volume control mode was at the forefront in the old anesthesia devices used in the OR, today
      there are anesthesia devices with many modes and features, as in intensive care units. This
      causes confusion in the use of mechanical ventilators in the perioperative period. Therefore,
      in this study, the investigators compared the perioperative mechanical power values in prone
      and supine positions, and postoperative pulmonary complications of two ventilation modes
      (volume control-pressure control ventilation). Thus, the investigators aimed to find out
      which ventilation mode would be advantageous in the perioperative period.
    

Intervention name(s): Position/Ventilation
Intervention type(s): Procedure
Intervention description(s): Positioning and ventilation mode adjustments were made to the patients.
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Cervical hernia, lumbar hernia and lumbar stabilization cases who were operated in the
        neurosurgery operating room of the anesthesia and reanimation clinic were examined.
      
Keywords: mechanical power; prone; supine; postoperative pulmonary complications