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The Potential Role of Lung-Protective Ventilation in Preventing Postoperative Delirium in Elderly Patients Undergoing Prone Spinal Surgery: A Preliminary Study

Jing Wang, Lian Zhu, Yanan Li, Chunping Yin, Zhiyong Hou, Qiujun Wang

Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)

Med Sci Monit 2020; 26:e926526

DOI: 10.12659/MSM.926526

Chinese Clinical Trial Registry # ChiCTR1900021155

Available online: 2020-08-18

Published: 2020-10-04

BACKGROUND: Postoperative delirium (POD) is a frequent complication in elderly patients, usually occurring within a few days after surgery. This study investigated the effect of lung-protective ventilation (LPV) on POD in elderly patients undergoing spinal surgery and the mechanism by which LPV suppresses POD.
MATERIAL AND METHODS: Seventy-one patients aged ≥65 years were randomized to receive LPV or conventional mechanical ventilation (MV), consisting of intermittent positive pressure ventilation following induction of anesthesia. The tidal volume in patients who received MV was 8 ml/kg predicted body weight (PBW), and the ventilation frequency was 12 times/min. The tidal volume in patients who received LPV was 6 ml/kg PBW, the positive end-expiratory pressure was 5 cmH₂O, and the ventilation frequency was 15 times/min, with a lung recruitment maneuver performed every 30 min. Blood samples were collected immediately before anesthesia induction (T₀), 10 min (T₁) and 60 min (T₂) after turning over, immediately after the operation (T₃), and 15 min after extubation (T₄) for blood gas analysis. Simultaneous cerebral oxygen saturation (rSO₂) and cerebral desaturation were recorded. Preoperative and postoperative serum concentrations of interleukin (IL)-6, IL-10 and glial fibrillary acidic protein (GFAP) were measured by ELISA. POD was assessed by nursing delirium screening score.
RESULTS: Compared with the MV group, pH was lower and PaCO₂ higher in the LPV group at T₂. In addition PaO₂, SaO₂, and PaO₂/FiO₂ were higher at T₁, and T₄, and rSO₂ was higher at T₃, and T₄ in the LPV than in the MV group (P<0.05 each). Postoperative serum GFAP and IL-6 were lower and IL-10 higher in the LPV group. The incidences of cerebral desaturation and POD were significantly lower in the LPV group (P<0.05).
CONCLUSIONS: LPV may reduce POD in elderly patients undergoing spinal surgery by inhibiting inflammation and improving cerebral oxygen metabolism.

Keywords: Aged, Cerebral Cortex, Delirium, Inflammation, Prone Position, Ventilation