| Effect of Different Extubation Strategies on Atelectasis in Older Adults after Major Abdominal Surgeries: A Prospective Randomised Controlled Trial |
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Rahul Madhukar Kashyap, Pradeep Bhatia, Tanvi M Meshram, Swati Chhabra, Rakesh Kumar |
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Department of Anaesthesiology and Critical care, All India Institute of Medical Sciences, Jodhpur, India |
Correspondence:
Tanvi M Meshram,
Email: Tanvimeshram162@gmail.com
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Received: 20 October 2023 • Revised: 9 January 2024 • Accepted: 15 March 2024 |
| Abstract |
Introduction: Older patients are particularly vulnerable to age-related respiratory changes. This prospective randomized controlled trial studied the effects of high and low fractions of inspired oxygen (FiO2) with the recruitment maneuver (RM) during extubation on lung atelectasis post-operatively in older patients undergoing major abdominal surgery.
Methods
We randomized a total of 132 patients aged >60 years who underwent both elective and emergency major abdominal surgeries and met the inclusion criteria into three groups (H, HR, and LR) using computer-generated block randomization. Group H received high FiO2 (1), Group HR received high FiO2 (1) with RM followed by a positive end-expiratory pressure of 5 cm H2O, and Group LR received low FiO2 (0.4) with RM followed by a positive end-expiratory pressure of 5 cm H2O 10 min before extubation. Oxygenation and atelectasis were measured using the arterial partial pressure of oxygen (PaO2)/FiO2 ratios and lung ultrasound score. Postoperative pulmonary complications were recorded up to 24 h postoperatively.
Results
The mean PaO2/FiO2 at 30 min post-extubation was significantly higher in Groups LR and HR compared to that in Group H (390.71 ± 29.55, 381.97 ± 24.97, and 355.37 ± 31.7, p <0.001). In the immediate postoperative period, the median lung ultrasound score was higher in Group H than that in Groups LR and HR (6 [5–7]), 3 [3–5], and 3.5 [2.25–4.75], p <0.001). The incidence of oxygen desaturation and oxygen requirements was higher in Group H during the postoperative period.
Conclusion
The RM before extubation is beneficial in reducing atelectasis and postoperative pulmonary complications, irrespective of the FiO2 concentration used in older adults undergoing major abdominal surgeries. |
| Key Words:
Atelectasis, Abdominal Surgeries, Extubation, Elderly, Fi02, Recruitment Manoeuvre |
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