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In this prospective, randomized trial, including patients scheduled for a major open or laparoscopic abdominal surgery (duration >2 hours) under general anesthesia , the investigators will compare 2 strategies of protective mechanical ventilation: a fixed intraoperative PEEP of 6 cmH2O and an individualized intraoperative PEEP according to the driving pressure.
Patients will be randomized into 2 groups:
The primary outcome: incidence of post operative pulmonary complications during the first post operative days.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Fixed PEEP group | No Intervention | Protective intraoperative ventilation with: 6 ml/kg IBW tidal volume recruitment maneuver and fixed PEEP¨level of 6 cmH2O | |
| Individualized PEEP group | Experimental | Protective intraoperative ventilation with: 6 ml/kg IBW tidal volume recruitment maneuver and individualized PEEP¨level in order to achieve the lowest driving pressure |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Peep individualization | Procedure | Intraoperative Peep individualization in order to achieve the lowest driving pressure |
|
| Measure | Description | Time Frame |
|---|---|---|
| incidence of pulmonary post operative complications | SpO2< 92%, new chest Xray infiltrates, acute respiratory failure requiring intervention | first 7 post operative days |
| Measure | Description | Time Frame |
|---|---|---|
| lung aeration score (LAS) | assessment LAS with lung ultrasound minimum 0 maximum: 36 (worse outcome) | day 1, day 3 and day 7 after surgery |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Mhamed Sami Mebazaa, full prof | Contact | 0021622252589 | msmebazaa@gmail.com | |
| Asma Ben Souissi, asso prof | Contact | 0021698336883 | bsouissiasma@gmail.com |
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