The PROtective Ventilation Using Open Lung Approach Or Not Trial

Postoperative Pulmonary Complications (PPC) are very common. It severely affects postoperative recovery, particularly in the abdominal surgery. Patients with laparoscopic resection of colorectal cancer generally have a higher age and decreased lung function reserve. At the same time, they prone to developing atelectasis due to the effects of pneumoperitoneum pressure. Therefore, they are a high-risk group of respiratory insufficiency and PPC. Mechanical ventilation with a low tidal volume is a routine in clinic nowadays. However, this conventional strategy will also result in atelectasis formation. Therefore, it may deteriorate the vulnerable lung function of patients undergoing laparoscopic resection of colorectal cancer. Patients with Acute Lung Injury or Acute Respiratory Distress Syndrome (ALI/ARDS) could benefit from the "open lung approach", including the use of positive end-expiratory pressure (PEEP) and recruitment maneuvers (RMs). Whether a lung protective mechanical ventilation strategy with medium levels of PEEP and repeated RMs, the "open lung approach", protects against respiratory insufficiency and PPC during laparoscopic resection of colorectal cancer is uncertain. The present study aims at comparing the effects of "open lung approach" mechanical ventilation strategy and conventional mechanical ventilation strategy in PPC, extra-pulmonary complications, length of hospital stay, biomarkers of lung injury and changes of respiratory function in patients undergoing general anesthesia for laparoscopic resection of colorectal cancer.

Sex

All

Minimum age

40 Years

Inclusion Criteria:

1. Age ≥ 40 years.
2. Undergo elective laparoscopic resection of colorectal cancer.
3. With an expected duration of pneumoperitoneum ≥1.5h.
4. With a preoperative risk index for pulmonary complications ≥ 2.
5. With no contraindication of epidural anesthesia.
6. Pulse oxygen saturation in air ≥ 92%.
7. And informed consent obtained.

Exclusion Criteria:

1. American Society of Anesthesiologists (ASA) physical status ≥ IV.
2. Body mass index ≥30kg/m2.
3. Duration of mechanical ventilation ≥ 1h within 2 weeks preceding surgery.
4. A history of acute respiratory failure within 1 month preceding surgery.
5. With a sepsis or septic shock or instable hemodynamics.
6. With a progressive neuromuscular illness such as myasthenia gravis.
7. With a epilepsy or schizophrenia or Parkinson's disease.
8. With a severe chronic obstructive pulmonary disease (COPD) or pulmonary bulla.
9. Severe organ dysfunction (acute coronary syndrome, uremia, hepatic encephalopathy, classification of function capacity of the NYHA ≥III, malignant arrhythmia and so on).
10. Coma, severe cognitive deficit, language or hearing impairment who cannot communicate.
11. Not proper controlled hypertension.
12. Involved in other clinical studies or refused to join in the research.

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