[Lung protective ventilation in elderly patients undergoing spinal operation in the prone position: a randomized controlled trial]

Abstract

Objective: To investigate effect of lung protective ventilation on respiration and circulation in elderly patients receiving spinal operation performed in the prone position.

Methods: Sixty patients undergoing elective spinal surgery were randomized control group [with VT of 10 mL/kg (PBW) and RR of 10-12 /min] and test group [with VT of 6 mL/kg +RMs+PEEP: 5 cmH(2)O (PBW) and RR of 12-18 /min]. Recruitment maneuver was performed once every 30 min. HR, MAP, P(peak), P(Plat), PaO(2)/FiO(2), SpO(2), PaCO(2), WBC, NEUT%, CRP, VAS, pulmonary complications risk score, and clinical pulmonary infection score were recorded before the operation, upon entry in the operation room, at 5 min before and 30 min, 1 h, and 3 h after changing into the prone position, and at 1 day and 3 days after the operation.

Results: Pulmonary complications risk score, HR, MAP, WBC, NEUT%, and PaCO(2) were all comparable between the two groups (P>0.05). P(peak) and P(plat) of the test group were lower than those of the control group after entering the operation room and at 5 min before and 30 min, 1 h, and 3 h after changing into the prone position (P<0.05). Compared with those in the control group, the oxygenation index at 1 day after the operation was significantly higher and CRP and postoperative clinical pulmonary infection score at 1 day and 3 days after the operation were significantly lower in the test group (P<0.05).

Conclusions: Lung protective ventilation can reduce the risk of barotrauma, reduce lung inflammation, and improve postoperative oxygenation in elderly patients undergoing spinal surgery in the prone position without affecting intraoperative hemodynamics or causing CO(2) retention.