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Effects of Intraoperative Lung-Protective Ventilation on Clinical Outcomes in Patients With Traumatic Brain Injury: A Randomized Controlled Trial
Ju Gao
Northern Jiangsu People's Hospital
Corresponding Author
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Background: Secondary lung injury is the most common non-neurological complication after traumatic brain injury (TBI). Lung-protective ventilation (LPV) has been proven to improve perioperative oxygenation and lung compliance in some critical patients. This study aimed to investigate whether intraoperative LPV could improve respiratory function and prevent postoperative complications in emergency TBI patients.
Methods: Ninety TBI patients were randomly allocated to three groups (1:1:1): Group A, conventional mechanical ventilation [tidal volume (VT) 10mL/kg only]; Group B, small VT (8mL/kg) + positive end-expiratory pressure (PEEP) (5cmH2O); Group C, small VT (8mL/kg) + PEEP (5cmH2O) + recruitment maneuvers (RMs). Primary outcomes were intraoperative respiratory mechanics parameters and incidences of postoperative pulmonary complications; Secondary outcomes were serum levels of brain injury markers and incidences of postoperative neurological complications.
Results: Seventy-nine patients completed final analysis. Intraoperative PaO2 and dynamic pulmonary compliance of Group B and C were higher than those of Group A (P=0.028; P=0.005), while their airway peak pressure and plateau pressure were lower than those of group A (P=0.004; P=0.005). Compared to Group A, postoperative 30-day incidences of hypoxemia, pulmonary infection and atelectasis of the other two groups significantly decreased (52.0% vs. 14.3% vs. 19.2%, P=0.005; 84.0% vs. 50.0% vs. 42.3%, P=0.006; 24.0% vs. 3.6% vs. 0.0%, P=0.004). Moreover, intraoperative hypotension in Group C was more frequent than that in Group A and B (P=0.007). At the end of surgery, serum levels of glial fibrillary acidic protein and ubiquitin carboxyl-terminal hydrolase isozyme L1 in Group B were lower than those in group A and C (P=0.002; P<0.001). Postoperative incidences of neurological complications among three groups were comparable.
Conclusions: Intraoperative continuous administration of small VT + PEEP is beneficial to TBI patients. Additional RMs with caution can be performed to prevent the disturbance of the stability of cerebral hemodynamics.
Trial registration: Chinese Clinical Trial Registry (ChiCTR2000038314), retrospectively registered on September 17, 2020.
Keywords
Traumatic brain injury, Lung-protective ventilation, Postoperative pulmonary complications, Optic nerve sheath diameter, Glial fibrillary acidic protein, Ubiquitin carboxyl-terminal hydrolase isozyme L1
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Reviewer #1 agreed
On 08 Jan, 2021
Reviewer #2 agreed
On 08 Jan, 2021
Reviewer #5 agreed
On 08 Jan, 2021
Reviewer #3 agreed
On 08 Jan, 2021
Reviewer #4 agreed
On 08 Jan, 2021
Reviewer #6 agreed
On 08 Jan, 2021
Reviewers invited
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Editor assigned
On 08 Jan, 2021
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On 01 Jan, 2021
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On 01 Jan, 2021
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On 14 Dec, 2020
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Subject Areas
Anesthesiology & Pain Medicine
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This preprint is under consideration at BMC Anesthesiology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Effects of Intraoperative Lung-Protective Ventilation on Clinical Outcomes in Patients With Traumatic Brain Injury: A Randomized Controlled Trial
Ju Gao
Northern Jiangsu People's Hospital
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 04 Jan, 2021
No community comments so far
Review #1 received
Received 18 Jan, 2021
Review #2 received
Received 18 Jan, 2021
Reviewer #1 agreed
On 08 Jan, 2021
Reviewer #2 agreed
On 08 Jan, 2021
Reviewer #5 agreed
On 08 Jan, 2021
Reviewer #3 agreed
On 08 Jan, 2021
Reviewer #4 agreed
On 08 Jan, 2021
Reviewer #6 agreed
On 08 Jan, 2021
Reviewers invited
Invitations sent on 08 Jan, 2021
Editor assigned
On 08 Jan, 2021
Editor invited
On 01 Jan, 2021
Submission checks complete
On 01 Jan, 2021
First submitted
On 14 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Secondary lung injury is the most common non-neurological complication after traumatic brain injury (TBI). Lung-protective ventilation (LPV) has been proven to improve perioperative oxygenation and lung compliance in some critical patients. This study aimed to investigate whether intraoperative LPV could improve respiratory function and prevent postoperative complications in emergency TBI patients.
Methods: Ninety TBI patients were randomly allocated to three groups (1:1:1): Group A, conventional mechanical ventilation [tidal volume (VT) 10mL/kg only]; Group B, small VT (8mL/kg) + positive end-expiratory pressure (PEEP) (5cmH2O); Group C, small VT (8mL/kg) + PEEP (5cmH2O) + recruitment maneuvers (RMs). Primary outcomes were intraoperative respiratory mechanics parameters and incidences of postoperative pulmonary complications; Secondary outcomes were serum levels of brain injury markers and incidences of postoperative neurological complications.
Results: Seventy-nine patients completed final analysis. Intraoperative PaO2 and dynamic pulmonary compliance of Group B and C were higher than those of Group A (P=0.028; P=0.005), while their airway peak pressure and plateau pressure were lower than those of group A (P=0.004; P=0.005). Compared to Group A, postoperative 30-day incidences of hypoxemia, pulmonary infection and atelectasis of the other two groups significantly decreased (52.0% vs. 14.3% vs. 19.2%, P=0.005; 84.0% vs. 50.0% vs. 42.3%, P=0.006; 24.0% vs. 3.6% vs. 0.0%, P=0.004). Moreover, intraoperative hypotension in Group C was more frequent than that in Group A and B (P=0.007). At the end of surgery, serum levels of glial fibrillary acidic protein and ubiquitin carboxyl-terminal hydrolase isozyme L1 in Group B were lower than those in group A and C (P=0.002; P<0.001). Postoperative incidences of neurological complications among three groups were comparable.
Conclusions: Intraoperative continuous administration of small VT + PEEP is beneficial to TBI patients. Additional RMs with caution can be performed to prevent the disturbance of the stability of cerebral hemodynamics.
Trial registration: Chinese Clinical Trial Registry (ChiCTR2000038314), retrospectively registered on September 17, 2020.
Figure 1
Figure 2