Ultrasound evaluation of different preventive measures of postoperative lung atelectasis after upper abdominal surgeries: ventilation and fluid measures

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Background and aim Atelectasis and pneumonia are instances of postoperative pulmonary complications (PPCs) that may arise following abdominal procedures. These complications contribute to an increase in morbidity and death rates. To enhance lung function and decrease the risk of PPC, it is possible to use recruitment maneuvers(RM), optimal fluid management, and protected lung ventilation with positive end-expiratory pressure (PEEP). Lung ultrasound is effective for early detection of PPC. This study aimed to assess preventive measures for postoperative lung atelectasis, focusing on ventilation and fluid management. Patients and methods A randomized, prospective, single-blinded, controlled study involved 60 patients who had elective open upper abdomen operations. Patients were assigned at random to one of three groups: group I: (PEEP group) administered PEEP of 8 cm H 2 O for ventilation, group II: PEEP and RM group (PEEP/RM) group and group III: PEEP, RM, and restrictive fluid (RF) group (PEEP/RM/RF group). Results None of the three groups differed significantly with regard to: surgical characteristics, hemodynamic parameters, fluid balance, pain scores, or postoperative complications. RM (with or without RF management) resulted in higher peak inspiratory pressure, improved arterial oxygenation (PaO₂ and PaO₂/FiO₂), and better lung aeration on ultrasound compared with PEEP alone, though no differences were found between the two RM groups. Despite improved oxygenation, PPCs incidence remained similar across all groups. Conclusions Post-upper abdomen operations, RM with PEEP enhanced oxygenation as well as lung aeration but did not reduce PPCs.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.