Surgery (Austin & Northern Health) - Theses

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Low tidal volume ventilation and postoperative outcomes after major surgery

Karalapillai, Sudharshan Christie ( 2022)

Millions of surgeries are undertaken every year worldwide. Mechanical ventilation is an essential component of many of these.Despite the essential nature of its use the ideal approach to mechanical ventilation is currently not known. Data from the critical care literature primarily in patients with acute respiratory distress syndrome suggest that low tidal volume ventilation is associated with significant improvement in outcomes.Whether this confers benefit in operative patients is unknown. This thesis sought to identify how Australian anaesthetists set the ventilator and administer oxygen during surgery. The impact of intra-operative low tidal volume ventilation, 6mL per kilogram versus conventional tidal volume strategy, 10mL per kilogram on a variety of postoperative outcomes was also studied. We found that in 2014 Australian anaesthetists set a conventional tidal volume of 10mL per kilogram lean body mass and administered high inspired fractions of oxygen during surgery.In a randomised controlled trial we found that low tidal volume ventilation did not reduce postoperative pulmonary or non pulmonary complications relative to a conventional ventilation strategy. This thesis suggests that a physiologic tidal volume of 6mL per kilogram is appropriate during major surgery given the absence of benefit of a supra-physiologic tidal volume.