PROTECTIVE VENTILATION AND POST-OPERATIVE RESPIRATORY COMPLICATIONS IN MAJOR PANCREATICODUODENAL SURGERY

Protective peri-operative ventilation can improve post-surgery outcomes and reduce the frequency of respiratory complications. The goal of the study was to evaluate the impact of ventilation with low respiratory volume solely or in combination with permissible hypercapnia (HC) on the outcomes of major pancreaticoduodenal surgery. Materials and methods. 60 patients were enrolled into prospective study who had planned pancreaticoduodenal operations lasting for more than 2 hours. All patients were randomly divided into 3 groups: mechanical ventilation with high respiratory volume (10 ml/kg of predicted body mass (PBM), HRV group, n = 20), low respiratory volume (6 ml/kg of PBM, LRV group, n = 20), and low respiratory volume with moderate HC (РаСО₂ 45–60 mm Hg., LRV+HC group, n = 20). Hemodynamic and respiratory parameters and frequency of complications were recorded in the peri-operative period. Results. Ratio of РаО₂ /FiO in 24 hours upon surgery completion was 15% higher in LRV group compared to HRV group. Higher frequency of atelectasis and prolonged hospital stay were typical of patients from HRV group. Lower concentration of arterial blood lactate was observed in the patients from LRV+HC group. Conclusion. Preventive reduction of respiratory volume in pancreaticoduodenal surgery improves the post-operative oxygenation, decreases the frequency of atelectasis and duration of hospital stay.

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