Pressure Support versus Spontaneous Ventilation during Anesthetic Emergence—Effect on Postoperative Atelectasis: A Randomized Controlled Trial
Despite previous reports suggesting that pressure support ventilation facilitates weaning from mechanical ventilation in the intensive care unit, few studies have assessed its effects on recovery from anesthesia. The authors hypothesized that pressure support ventilation during emergence from anesth...
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| Veröffentlicht in: | Anesthesiology (Philadelphia) 2021-12, Vol.135 (6), p.1004-1014 |
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| creator | Jeong, Heejoon Tanatporn, Pisitpitayasaree Ahn, Hyun Joo Yang, Mikyung Kim, Jie Ae Yeo, Hyean Kim, Woojin |
| description | Despite previous reports suggesting that pressure support ventilation facilitates weaning from mechanical ventilation in the intensive care unit, few studies have assessed its effects on recovery from anesthesia. The authors hypothesized that pressure support ventilation during emergence from anesthesia reduces postoperative atelectasis in patients undergoing laparoscopic surgery using the Trendelenburg position.
In this randomized controlled double-blinded trial, adult patients undergoing laparoscopic colectomy or robot-assisted prostatectomy were assigned to either the pressure support (n = 50) or the control group (n = 50). During emergence (from the end of surgery to extubation), pressure support ventilation was used in the pressure support group versus intermittent manual assistance in the control group. The primary outcome was the incidence of atelectasis diagnosed by lung ultrasonography at the postanesthesia care unit (PACU). The secondary outcomes were Pao2 at PACU and oxygen saturation measured by pulse oximetry less than 92% during 48 h postoperatively.
Ninety-seven patients were included in the analysis. The duration of emergence was 9 min and 8 min in the pressure support and control groups, respectively. The incidence of atelectasis at PACU was lower in the pressure support group compared to that in the control group (pressure support vs. control, 16 of 48 [33%] vs. 28 of 49 [57%]; risk ratio, 0.58; 95% CI, 0.35 to 0.91; P = 0.024). In the PACU, Pao2 in the pressure support group was higher than that in the control group (92 ± 26 mmHg vs. 83 ± 13 mmHg; P = 0.034). The incidence of oxygen saturation measured by pulse oximetry less than 92% during 48 h postoperatively was not different between the groups (9 of 48 [19%] vs. 11 of 49 [22%]; P = 0.653). There were no adverse events related to the study protocol.
The incidence of postoperative atelectasis was lower in patients undergoing either laparoscopic colectomy or robot-assisted prostatectomy who received pressure support ventilation during emergence from general anesthesia compared to those receiving intermittent manual assistance. |
| doi_str_mv | 10.1097/ALN.0000000000003997 |
| format | Article |
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In this randomized controlled double-blinded trial, adult patients undergoing laparoscopic colectomy or robot-assisted prostatectomy were assigned to either the pressure support (n = 50) or the control group (n = 50). During emergence (from the end of surgery to extubation), pressure support ventilation was used in the pressure support group versus intermittent manual assistance in the control group. The primary outcome was the incidence of atelectasis diagnosed by lung ultrasonography at the postanesthesia care unit (PACU). The secondary outcomes were Pao2 at PACU and oxygen saturation measured by pulse oximetry less than 92% during 48 h postoperatively.
Ninety-seven patients were included in the analysis. The duration of emergence was 9 min and 8 min in the pressure support and control groups, respectively. The incidence of atelectasis at PACU was lower in the pressure support group compared to that in the control group (pressure support vs. control, 16 of 48 [33%] vs. 28 of 49 [57%]; risk ratio, 0.58; 95% CI, 0.35 to 0.91; P = 0.024). In the PACU, Pao2 in the pressure support group was higher than that in the control group (92 ± 26 mmHg vs. 83 ± 13 mmHg; P = 0.034). The incidence of oxygen saturation measured by pulse oximetry less than 92% during 48 h postoperatively was not different between the groups (9 of 48 [19%] vs. 11 of 49 [22%]; P = 0.653). There were no adverse events related to the study protocol.
The incidence of postoperative atelectasis was lower in patients undergoing either laparoscopic colectomy or robot-assisted prostatectomy who received pressure support ventilation during emergence from general anesthesia compared to those receiving intermittent manual assistance.</description><identifier>ISSN: 0003-3022</identifier><identifier>EISSN: 1528-1175</identifier><identifier>DOI: 10.1097/ALN.0000000000003997</identifier><identifier>PMID: 34610099</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Aged ; Anesthesia Recovery Period ; Anesthesia, General - adverse effects ; Anesthesia, General - methods ; Double-Blind Method ; Female ; Humans ; Male ; Middle Aged ; Oxygen Saturation - physiology ; Positive-Pressure Respiration - methods ; Postoperative Complications - diagnostic imaging ; Postoperative Complications - etiology ; Postoperative Complications - prevention & control ; Pressure ; Prospective Studies ; Pulmonary Atelectasis - diagnostic imaging ; Pulmonary Atelectasis - etiology ; Pulmonary Atelectasis - prevention & control ; Respiration, Artificial - methods</subject><ispartof>Anesthesiology (Philadelphia), 2021-12, Vol.135 (6), p.1004-1014</ispartof><rights>Lippincott Williams & Wilkins</rights><rights>Copyright © 2021, the American Society of Anesthesiologists. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3989-7a41f7dfb5ebb38d57c58d60b230b9dedd4456ec77e15f7b507a88a6834181193</citedby><cites>FETCH-LOGICAL-c3989-7a41f7dfb5ebb38d57c58d60b230b9dedd4456ec77e15f7b507a88a6834181193</cites><orcidid>0000-0001-5300-2550</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34610099$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jeong, Heejoon</creatorcontrib><creatorcontrib>Tanatporn, Pisitpitayasaree</creatorcontrib><creatorcontrib>Ahn, Hyun Joo</creatorcontrib><creatorcontrib>Yang, Mikyung</creatorcontrib><creatorcontrib>Kim, Jie Ae</creatorcontrib><creatorcontrib>Yeo, Hyean</creatorcontrib><creatorcontrib>Kim, Woojin</creatorcontrib><title>Pressure Support versus Spontaneous Ventilation during Anesthetic Emergence—Effect on Postoperative Atelectasis: A Randomized Controlled Trial</title><title>Anesthesiology (Philadelphia)</title><addtitle>Anesthesiology</addtitle><description>Despite previous reports suggesting that pressure support ventilation facilitates weaning from mechanical ventilation in the intensive care unit, few studies have assessed its effects on recovery from anesthesia. The authors hypothesized that pressure support ventilation during emergence from anesthesia reduces postoperative atelectasis in patients undergoing laparoscopic surgery using the Trendelenburg position.
In this randomized controlled double-blinded trial, adult patients undergoing laparoscopic colectomy or robot-assisted prostatectomy were assigned to either the pressure support (n = 50) or the control group (n = 50). During emergence (from the end of surgery to extubation), pressure support ventilation was used in the pressure support group versus intermittent manual assistance in the control group. The primary outcome was the incidence of atelectasis diagnosed by lung ultrasonography at the postanesthesia care unit (PACU). The secondary outcomes were Pao2 at PACU and oxygen saturation measured by pulse oximetry less than 92% during 48 h postoperatively.
Ninety-seven patients were included in the analysis. The duration of emergence was 9 min and 8 min in the pressure support and control groups, respectively. The incidence of atelectasis at PACU was lower in the pressure support group compared to that in the control group (pressure support vs. control, 16 of 48 [33%] vs. 28 of 49 [57%]; risk ratio, 0.58; 95% CI, 0.35 to 0.91; P = 0.024). In the PACU, Pao2 in the pressure support group was higher than that in the control group (92 ± 26 mmHg vs. 83 ± 13 mmHg; P = 0.034). The incidence of oxygen saturation measured by pulse oximetry less than 92% during 48 h postoperatively was not different between the groups (9 of 48 [19%] vs. 11 of 49 [22%]; P = 0.653). There were no adverse events related to the study protocol.
The incidence of postoperative atelectasis was lower in patients undergoing either laparoscopic colectomy or robot-assisted prostatectomy who received pressure support ventilation during emergence from general anesthesia compared to those receiving intermittent manual assistance.</description><subject>Aged</subject><subject>Anesthesia Recovery Period</subject><subject>Anesthesia, General - adverse effects</subject><subject>Anesthesia, General - methods</subject><subject>Double-Blind Method</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Oxygen Saturation - physiology</subject><subject>Positive-Pressure Respiration - methods</subject><subject>Postoperative Complications - diagnostic imaging</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - prevention & control</subject><subject>Pressure</subject><subject>Prospective Studies</subject><subject>Pulmonary Atelectasis - diagnostic imaging</subject><subject>Pulmonary Atelectasis - etiology</subject><subject>Pulmonary Atelectasis - prevention & control</subject><subject>Respiration, Artificial - methods</subject><issn>0003-3022</issn><issn>1528-1175</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUctu1DAUtRCIDoU_QMhLNmn9iGObXTQaHtIIKlrYRk580wk4cbCdVrDiE1jwhf0SPJqWIixZvtc-51zfexB6TskJJVqe1tv3J-SfxbWWD9CKCqYKSqV4iFb724ITxo7Qkxi_5FQKrh6jI15WlBCtV-jXWYAYlwD4fJlnHxK-ghCXiM9nPyUzgc_xZ5jS4Ewa_ITtEobpEtcTxLSDNHR4M0K4hKmDm5-_N30PXcIZd-Zj8jOEzLoCXCdw-cHEIb7CNf5oJuvH4QdYvM5lgncuhxdhMO4petQbF-HZ7XmMPr3eXKzfFtsPb96t623Rca10IU1Je2n7VkDbcmWF7ISyFWkZJ622YG1Zigo6KYGKXraCSKOUqRQvqaJU82P08qA7B_9tyc004xA7cO7Qc8OE1BVTotpDywO0Cz7GAH0zh2E04XtDSbP3osleNP97kWkvbiss7Qj2L-lu-Pe6196lPPWvbrmG0OzAuLQ76ImSFYwwSllOirzzz_8AMjiYRg</recordid><startdate>20211201</startdate><enddate>20211201</enddate><creator>Jeong, Heejoon</creator><creator>Tanatporn, Pisitpitayasaree</creator><creator>Ahn, Hyun Joo</creator><creator>Yang, Mikyung</creator><creator>Kim, Jie Ae</creator><creator>Yeo, Hyean</creator><creator>Kim, Woojin</creator><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5300-2550</orcidid></search><sort><creationdate>20211201</creationdate><title>Pressure Support versus Spontaneous Ventilation during Anesthetic Emergence—Effect on Postoperative Atelectasis: A Randomized Controlled Trial</title><author>Jeong, Heejoon ; Tanatporn, Pisitpitayasaree ; Ahn, Hyun Joo ; Yang, Mikyung ; Kim, Jie Ae ; Yeo, Hyean ; Kim, Woojin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3989-7a41f7dfb5ebb38d57c58d60b230b9dedd4456ec77e15f7b507a88a6834181193</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Anesthesia Recovery Period</topic><topic>Anesthesia, General - adverse effects</topic><topic>Anesthesia, General - methods</topic><topic>Double-Blind Method</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Oxygen Saturation - physiology</topic><topic>Positive-Pressure Respiration - methods</topic><topic>Postoperative Complications - diagnostic imaging</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - prevention & control</topic><topic>Pressure</topic><topic>Prospective Studies</topic><topic>Pulmonary Atelectasis - diagnostic imaging</topic><topic>Pulmonary Atelectasis - etiology</topic><topic>Pulmonary Atelectasis - prevention & control</topic><topic>Respiration, Artificial - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jeong, Heejoon</creatorcontrib><creatorcontrib>Tanatporn, Pisitpitayasaree</creatorcontrib><creatorcontrib>Ahn, Hyun Joo</creatorcontrib><creatorcontrib>Yang, Mikyung</creatorcontrib><creatorcontrib>Kim, Jie Ae</creatorcontrib><creatorcontrib>Yeo, Hyean</creatorcontrib><creatorcontrib>Kim, Woojin</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Anesthesiology (Philadelphia)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jeong, Heejoon</au><au>Tanatporn, Pisitpitayasaree</au><au>Ahn, Hyun Joo</au><au>Yang, Mikyung</au><au>Kim, Jie Ae</au><au>Yeo, Hyean</au><au>Kim, Woojin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pressure Support versus Spontaneous Ventilation during Anesthetic Emergence—Effect on Postoperative Atelectasis: A Randomized Controlled Trial</atitle><jtitle>Anesthesiology (Philadelphia)</jtitle><addtitle>Anesthesiology</addtitle><date>2021-12-01</date><risdate>2021</risdate><volume>135</volume><issue>6</issue><spage>1004</spage><epage>1014</epage><pages>1004-1014</pages><issn>0003-3022</issn><eissn>1528-1175</eissn><abstract>Despite previous reports suggesting that pressure support ventilation facilitates weaning from mechanical ventilation in the intensive care unit, few studies have assessed its effects on recovery from anesthesia. The authors hypothesized that pressure support ventilation during emergence from anesthesia reduces postoperative atelectasis in patients undergoing laparoscopic surgery using the Trendelenburg position.
In this randomized controlled double-blinded trial, adult patients undergoing laparoscopic colectomy or robot-assisted prostatectomy were assigned to either the pressure support (n = 50) or the control group (n = 50). During emergence (from the end of surgery to extubation), pressure support ventilation was used in the pressure support group versus intermittent manual assistance in the control group. The primary outcome was the incidence of atelectasis diagnosed by lung ultrasonography at the postanesthesia care unit (PACU). The secondary outcomes were Pao2 at PACU and oxygen saturation measured by pulse oximetry less than 92% during 48 h postoperatively.
Ninety-seven patients were included in the analysis. The duration of emergence was 9 min and 8 min in the pressure support and control groups, respectively. The incidence of atelectasis at PACU was lower in the pressure support group compared to that in the control group (pressure support vs. control, 16 of 48 [33%] vs. 28 of 49 [57%]; risk ratio, 0.58; 95% CI, 0.35 to 0.91; P = 0.024). In the PACU, Pao2 in the pressure support group was higher than that in the control group (92 ± 26 mmHg vs. 83 ± 13 mmHg; P = 0.034). The incidence of oxygen saturation measured by pulse oximetry less than 92% during 48 h postoperatively was not different between the groups (9 of 48 [19%] vs. 11 of 49 [22%]; P = 0.653). There were no adverse events related to the study protocol.
The incidence of postoperative atelectasis was lower in patients undergoing either laparoscopic colectomy or robot-assisted prostatectomy who received pressure support ventilation during emergence from general anesthesia compared to those receiving intermittent manual assistance.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>34610099</pmid><doi>10.1097/ALN.0000000000003997</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-5300-2550</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; Journals@Ovid Complete |
| subjects | Aged Anesthesia Recovery Period Anesthesia, General - adverse effects Anesthesia, General - methods Double-Blind Method Female Humans Male Middle Aged Oxygen Saturation - physiology Positive-Pressure Respiration - methods Postoperative Complications - diagnostic imaging Postoperative Complications - etiology Postoperative Complications - prevention & control Pressure Prospective Studies Pulmonary Atelectasis - diagnostic imaging Pulmonary Atelectasis - etiology Pulmonary Atelectasis - prevention & control Respiration, Artificial - methods |
| title | Pressure Support versus Spontaneous Ventilation during Anesthetic Emergence—Effect on Postoperative Atelectasis: A Randomized Controlled Trial |
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