多中心观察性研究.pptVIP

A multicentre observational study of intra-operative ventilatory management during general anaesthesia: tidal volumes and relation to body weight Anaesthesia 2012 W orldwide, millions of patients require mechanical ventilation each year for surgical procedures performed during general anaesthesia. Both experimental and clinical studies have suggested that mechanical ventilation using large tidal volumes could initiate lung injury in healthy lungs, a phenomenon referred as ventilator induced lung injury . Large epidemiological studies of ventilatory practices in patients in the intensive care unit(ICU) have been performed both in Europe and in the USA . However, similar multicentre studies are lacking for surgical patients receiving general anaesthesia in the operating room. This is important as mechanical ventilation during surgery differs from that performed in ICU. Application of the ‘protective lung ventilation concept’ (low tidal volume with positive end-expiratory pressure (PEEP)) was first evaluated in patients with acute respiratory distress syndrome (ARDS) and resulted in decreased mortality . This approach is now widely recommended in acute lung injury (ALI) or ARDS . However, there are no similar recommendations for optimal tidal volume in patients without lung injury, whether in the ICU or in the operating room. The aims of this study were first to describe intra-operative ventilatory practices (with particular focus on the use of a large tidal volume) and second, to identify patient factors that could be associated with this practice. Materials and methods We conducted an observational prospective study performed between January and June 2006 in 97 anaesthesia units from 49 French hospitals. Each unit included 30 consecutive adult patients who received mechanical ventilation during surgery. Materials and methods Data related to the patient included: age, sex, height, weight, body mass index (BMI), A