The thesis is devoted to the improvement of treatment results of patients with moderate and high risk of development of postoperative pulmonary complications in abdominal surgery by developing an individualized comprehensive perioperative approach of respiratory support.
Post-operative pulmonary complications (PPCs) are one of the most common non-surgical complications after abdominal operative intervention. The development of PPCs is the most important independent predictor of 30-day mortality and has a negative impact on long-term clinical outcomes.
Perioperative strategies for the prevention of pulmonary complications may improve patients’ treatment results. This is especially important for patients who are at increased risk for developing the PPC, but this issue is still not sufficiently addressed. To eliminate this scientific and practical drawback, it was decided to conduct this study.
The project consisted of two parts. The first stage investigated the state of the problem in the world, analyzed the current literature on the optimization of respiratory support to prevent the development of PPC. The result of this phase of the study was the identification of unexplored issues that need to be detected. Among them are studies of the effect of preoperative usage of incentive spirometry (IS) on indicators of external lung function (ELF) and the development of pulmonary complications in the postoperative period; assessment of the effect of intraoperative individualized respiratory support on hemodynamics and respiratory mechanics; development of complex perioperative respiratory support for patients with moderate and high risk of developing PPC on the ARISCAT scale in abdominal surgery and evaluation of its effectiveness as a way to prevent pulmonary complications.
The next stage was a prospective study, which consistently included 92 patients who under general anesthesia underwent open surgery on the abdominal organs in the period from September 2016 to December 2018. Inclusion criteria were: age over 18 years, the presence of moderate or high risk of postoperative pulmonary complications on the ARISCAT scale, surgery on the upper abdominal cavity, the expected duration of surgery more than 2 hours. Depending on the perioperative ventilation strategy, patients were divided into two groups. The first group (n = 45) included patients who underwent "standard" mechanical ventilation in the intraoperative period with a tidal volume (TV) of 8-10 ml/kg of ideal body weight (IdBW). Patients of the second group (n = 47) underwent comprehensive perioperative respiratory support, which included individualized intraoperative protective ventilation and IS classes in the pre- and postoperative period. The incidence of pulmonary complications such as pneumothorax, pulmonary atelectasis, pneumonia, pleural effusion, and hypoxemia was determined in the study groups during the postoperative week.
At the intraoperative stage of the study in both groups studied the effect of ventilation support on hemodynamic parameters (systolic blood pressure (SBP, mm Hg), diastolic blood pressure (DBP, mm Hg), mean blood pressure (MBP, mm Hg), heart rate (HR, beats/min), stroke volume (SV, ml) and cardiac index (CI,
l×min-1/m2)). The studied parameters were recorded after intubation, in group 2 after RM, as well as on the 30th, 60th, 90th, 120th, 150th, 180th minutes of the study, depending on the duration of the operation. Cases of hypotension and bradycardia were recorded intraoperatively.
