ObjectiveTo investigate the current status of routine practice and perspective of anesthesiologists regarding ventilation strategies during cardiac surgery, and to analyze whether there is a gap between the clinical application and theoretical understanding of lung-protective ventilation (LPV) strategies. MethodsWe conducted a multi-institutional cross-sectional survey of anesthesiologists working at high-volume (>1000 cardiac procedures each year) Chinese hospitals. The electronic questionnaire was designed and distributed from September 2021 to February 2022. ResultsA total of 323 replies were collected and 297 (92.0%) replies were valid. Among the respondents, 84.8% (252/297) performed the combination of low tidal volume (VT), positive end-expiratory pressure (PEEP) and alveolar recruitment maneuver (ARM) during non-CPB period. The vast majority of respondents (90.6%, 269/297) ventilated patients with the VT of 6-8 mL/kg. 92.3% (274/297) of respondents applied PEEP, among those 57.9% (172/297) set a PEEP level <5 cm H2O. Most of the respondents (67.3%, 200/297) performed intraoperative ARM, and manual ARM was used by 86.2% (256/297) of anesthesiologists. During CPB, 89.9% (267/297) of respondents withdrew mechanical ventilation, and 29.6% (88/297) performed ARM. ConclusionThis national survey in China showed that the majority of anesthesiologists adopted LPV strategy with the combination of low VT, PEEP and ARM during cardiac surgery. Except VT, the intraoperative ventilator settings varied widely from one anesthesiologist to another. Meanwhile, there is a gap between the clinical practice and theoretical understanding of LPV.
Perioperative mechanical ventilation plays a role in lung injury and postoperative pulmonary complications, yet a consensus in the literature concerning the key clinical question of how to best provide lung protection during mechanical ventilation in surgical patients is lacking. It is necessary to develop an expert consensus on perioperative mechanical ventilation suitable for Chinese anesthesiologists to better guide clinical practice. The experts from the Anesthesia Committee of Chengdu Medical Association and the Chongqing Medical Association Anesthesiology Branch were organized by West China Hospital of Sichuan University to propose the question regarding the perioperative mechanical ventilation, and the current literature was then reviewed, and expert opinions were solicited to provide evidence-based guidance. Subsequently, the expert panel reached a consensus and formulated 28 recommendations with evidence of moderate to high quality using the modified Delphi method.
ObjectiveTo evaluate the clinical efficacy and safety of a perioperative lung protective protocol specifically adapted for minimally invasive esophagectomy (MIE) in high-altitude hypoxic environments, thereby providing evidence-based guidelines for MIE in high-altitude regions. MethodsThis retrospective study analyzed the clinical data of 69 patients (a study group) who underwent combined thoracoscopic and laparoscopic esophagectomy with a high-altitude-specific lung protective strategy at Qinghai Provincial People’s Hospital from March 2022 to November 2024. A historical control group comprised 67 patients (control group) who underwent the same surgery without this protocol from March 2020 to February 2022. Propensity score matching was employed to balance baseline covariates. The study group received a comprehensive lung protective protocol encompassing preoperative pulmonary function assessment and optimization, individualized lung protective ventilation and meticulous anesthesia management during surgery, and standardized enhanced recovery after surgery. Primary outcome measures included surgical duration, intraoperative blood loss, oxygenation index during one-lung ventilation, incidence of postoperative complications, pulmonary function recovery trajectory, and long-term disease-free survival. ResultsAfter propensity score matching, 58 patients [44 males, 14 females; mean age (62.3±8.5) years] were included in the study group, and 55 patients [41 males, 14 females; mean age (61.8±9.2) years] in the control group. Surgical duration was significantly shorter in the study group [ (289.7±26.1) min vs. (312.6±30.3) min, P<0.001], and intraoperative blood loss was significantly lower [ (187.0±12.6) mL vs. (215.4±18.5) mL, P<0.001]. During one-lung ventilation, the PaO2/FiO2 ratio was significantly higher in the study group [ (285.6±45.2) mm Hg] compared to the control group [ (210.3±39.7) mm Hg, P<0.001]. The incidence of overall postoperative complications (15.5% vs. 32.7%, P=0.031) and pulmonary complications (6.9% vs. 21.8%, P=0.012) was significantly lower in the study group. At 7 days postoperatively, forced vital capacity and forced expiratory volume in 1 second recovered to 85.6% and 83.2% of preoperative levels, respectively, and approached preoperative levels by 6 months. The 12-month disease-free survival rate was 91.4% in the study group, which was superior to 83.6% in the control group (log-rank χ2=4.521, P=0.033). ConclusionThe perioperative lung protective protocol, specifically designed for high-altitude hypoxic environments, is safe and effective. It significantly improves intraoperative oxygenation, reduces postoperative complications, accelerates pulmonary function recovery, and does not compromise oncological radicality. This protocol offers a standardized practice guideline for minimally invasive esophagectomy in regions with altitudes ranging from 2 260 to 3 200 meters.