title: Effects of different ventilation strategies on exhaled nitric oxide in geriatric abdominal surgery.
abstract: Exhaled nitric oxide (eNO) has been suggested to be a marker of small airway injury. We investigated the effects of different ventilation strategies on eNO. Sixty-nine patients who received elective open abdominal surgery under general anesthesia with more than 2 h of surgery duration were randomly divided into three groups: high tidal volume of 10-12 ml kg(-1) predicted body weight (PBW) with zero end-expiratory pressure (ZEEP) (high VT + ZEEP group); low tidal volume of 6-8 ml kg(-1) PBW with 8 cm H2O positive end-expiratory pressure (PEEP) (low VT + PEEP group); and low tidal volume of 6-8 ml kg(-1) PBW with 8 cm H2O PEEP and recruitment maneuvers (low VT + PEEP + RMs group). eNO, respiratory system compliance (Crs), oxygenation index, inflammatory mediators tumor necrosis factor-alpha (TNF-α), interleukin-1β (IL-1β), IL-8, prostaglandin E2 (PGE2) and PGF2a as well as pulmonary function were measured during the perioperative period. The postoperative eNO decreased in 78.3% of patients in the high VT + ZEEP group and low VT + PEEP group, and increased in 56.5% of patients in the low VT + PEEP + RMs group (P = 0.016). The Crs level in the high VT + ZEEP group significantly decreased with time but significantly increased in the low VT + PEEP + RMs group (P < 0.05). The oxygenation index, inflammatory mediators and pulmonary function did not statistically differ among the three groups. Compared with the low VT + PEEP + RMs group, the decreasing rate of postoperative eNO in the high VT + ZEEP and low VT + PEEP groups was higher, which may imply small airway injury during geriatric abdominal surgery.
authors.affiliation: Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China.
authors.forename: Yinghua
authors.initials: Y
authors.lastname: Cui
authors.forename: Xin
authors.initials: X
authors.lastname: Pi
authors.forename: Changsong
authors.initials: C
authors.lastname: Wang
authors.forename: Shujuan
authors.initials: S
authors.lastname: Liu
authors.forename: Yulei
authors.initials: Y
authors.lastname: Gong
authors.forename: Yang
authors.initials: Y
authors.lastname: Wang
authors.forename: Fan
authors.initials: F
authors.lastname: Zhang
authors.forename: Jinghui
authors.initials: J
authors.lastname: Shi
authors.forename: Ziwei
authors.initials: Z
authors.lastname: Lin
authors.forename: Xin
authors.initials: X
authors.lastname: Zhang
authors.forename: Enyou
authors.initials: E
authors.lastname: Li
mesh_terms: D000368:Aged; D001944:Breath Tests; D045853:Exhalation / Q000502:physiology*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism*; D011175:Positive-Pressure Respiration / Q000009:adverse effects; D013514:Surgical Procedures, Operative; D013990:Tidal Volume; D055397:Ventilator-Induced Lung Injury / Q000209:etiology / Q000517:prevention & control*
chemical_list: D009569:Nitric Oxide