title: Protective Ventilation Improves Gas Exchange, Reduces Incidence of Atelectases, and Affects Metabolic Response in Major Pancreatoduodenal Surgery.
abstract: BACKGROUND
  Protective perioperative ventilation has been shown to improve outcomes and reduce the incidence of postoperative pulmonary complications. The goal of this study was to assess the effects of ventilation with low tidal volume (VT) either alone or in a combination with moderate permissive hypercapnia in major pancreatoduodenal interventions.
  
  
  METHODS
  Sixty adult patients scheduled for elective pancreatoduodenal surgery with duration >2 h were enrolled into a prospective single-center study. All patients were randomized to three groups receiving high VT[10 mL/kg of predicted body weight (PBW), the HVT group,n= 20], low VT(6 mL/kg PBW, the LVT group,n= 20), and low VTcombined with a moderate hypercapnia and hypercapnic acidosis (6 mL/kg PBW, PaCO245-60 mm Hg, the LVT + HC group,n= 20). Cardiopulmonary parameters and the incidence of complications were registered during surgery and postoperatively.
  
  
  CONCLUSIONS
  The values of VTwere 610 (563-712), 370 (321-400), and 340 (312-430) mL/kg for the HVT, the LVT, and the LVT + HC groups, respectively (p< 0.001). Compared to the HVT group, PaO2/FiO2ratio was increased in the LVT group by 15%: 333 (301-381) vs. 382 (349-423) mm Hg at 24 h postoperatively (p< 0.05). The HVT group had significantly higher incidence of atelectases (n= 6), despite lower incidence of smoking compared with the LVT (n= 1) group (p= 0.017) and demonstrated longer length of hospital stay. The patients of the LVT + HC group had lower arterial lactate and bicarbonate excess values by the end of surgery.
  
  
  CONCLUSIONS
  In major pancreatoduodenal interventions, preventively protective VTimproves postoperative oxygenation, reduces the incidence of atelectases, and shortens length of hospital stay. The combination of low VTand permissive hypercapnia results in hypercapnic acidosis decreasing the lactate concentration but adding no additional benefits and warrants further investigations.
authors.affiliation: Department of Anesthesiology and Intensive Care, Northern State Medical University, Arkhangelsk, Russian Federation; Department of Anesthesiology, City Hospital # 1, Arkhangelsk, Russian Federation.
authors.forename: Vsevolod V
authors.initials: VV
authors.lastname: Kuzkov
authors.affiliation: Department of Anesthesiology and Intensive Care, Northern State Medical University, Arkhangelsk, Russian Federation; Department of Anesthesiology, City Hospital # 1, Arkhangelsk, Russian Federation.
authors.forename: Ludmila N
authors.initials: LN
authors.lastname: Rodionova
authors.affiliation: Department of Anesthesiology and Intensive Care, Northern State Medical University, Arkhangelsk, Russian Federation; Department of Anesthesiology, City Hospital # 1, Arkhangelsk, Russian Federation.
authors.forename: Yana Y
authors.initials: YY
authors.lastname: Ilyina
authors.affiliation: Department of Anesthesiology and Intensive Care, Northern State Medical University , Arkhangelsk , Russian Federation.
authors.forename: Aleksey A
authors.initials: AA
authors.lastname: Ushakov
authors.affiliation: Department of Anesthesiology and Intensive Care, Northern State Medical University, Arkhangelsk, Russian Federation; Department of Anesthesiology, City Hospital # 1, Arkhangelsk, Russian Federation.
authors.forename: Maria M
authors.initials: MM
authors.lastname: Sokolova
authors.affiliation: Department of Anesthesiology and Intensive Care, Northern State Medical University, Arkhangelsk, Russian Federation; Department of Anesthesiology, City Hospital # 1, Arkhangelsk, Russian Federation.
authors.forename: Eugenia V
authors.initials: EV
authors.lastname: Fot
authors.affiliation: Department of Surgery, Northern State Medical University , Arkhangelsk , Russian Federation.
authors.forename: Boris L
authors.initials: BL
authors.lastname: Duberman
authors.affiliation: Department of Anesthesiology and Intensive Care, Northern State Medical University, Arkhangelsk, Russian Federation; Department of Anesthesiology, City Hospital # 1, Arkhangelsk, Russian Federation.
authors.forename: Mikhail Y
authors.initials: MY
authors.lastname: Kirov
keywords: atelectasis; pancreatoduodenal surgery; permissive hypercapnia; postoperative pulmonary complications; protective ventilation