Effects of inverse ratio ventilation combined with lung protective ventilation on pulmonary function in patients with severe burns for surgery

• Published in: Libyan journal of medicine Vol. 15; no. 1; p. 1767276
• Main Authors: Yang, Yan-Chao, Huai, Qiao, Cui, Shu-Zhen, Cao, Xiao-Wei, Gao, Bu-Lang
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 01.01.2020; Taylor & Francis Ltd; Taylor & Francis Group
• Subjects: Anesthesiology; Burns; Carbon dioxide; Edema; General anesthesia; Hospitals; hypoxemia; Inflammatory factor; Normal distribution; Original; pulmonary edema; Skin & tissue grafts; Standard deviation; Statistical analysis; Surgery; thermal injury; ventilation-perfusion mismatch; Ventilators; pulmonary edema; hypoxemia; ventilation–perfusion mismatch; Inflammatory factor; thermal injury
• ISSN: 1993-2820; 1819-6357
• DOI: 10.1080/19932820.2020.1767276

To investigate the effects of inverse ratio ventilation combined with lung-protective ventilation on pulmonary function and inflammatory factors in severe burn patients undergoing surgery. Populations and Methods: Eighty patients with severe burns undergoing elective surgery were divided randomly into two groups: control (CG, n = 40) and experiment (EG, n = 40). The CG had conventional ventilation, whereas the EG were ventilated with tidal volume (TV) of 6-8 ml/kg, I (inspiration): E (expiration) of 2:1, and positive end-expiratory pressure (PEEP) 5 cm H2O. The following variables were evaluated before (T0), 1 h after start of surgery (T1) and after surgery (T2): oxygenation index (OI), partial pressure of carbon dioxide (PaCO 2 ), TV, peak airway pressure (Ppeak), mean airway pressure (Pmean), PEEP, pulmonary dynamic compliance (Cdyn), alveolar-arterial difference of oxygen partial pressure D(A-a)O 2 , lactic acid (Lac), interleukin (IL)-6 and IL-10, and lung complications. Results: At T1 and T2 time points, the OI, Pmean and Cdyn were significantly greater in the EG than in the CG while the TV, Ppeak, D(A-a)O 2 , IL-6 and IL-10 were significantly smaller in the EG than in the CG. At the end of the surgery, the Lac was significantly smaller in the EG than in the CG (1.28 ± 0.19 vs. 1.40 ± 0.23 mmol/L). Twenty-four hours after the surgery, significantly more patients had hypoxemia (27.5 vs. 10.0%), increased expectoration (45.0 vs. 22.5%), increased lung texture or exudation (37.5 vs. 17.5%) in the CG than in the EG. Conclusions: Inverse ratio ventilation combined with lung-protective ventilation can reduce Ppeak, increase Pmean and Cdyn, improve the pulmonary oxygenation function, and decrease ILs in severe burn surgery patients.