INCIDENCE OF POST OPERATIVE PULMONARY COMPLICATIONS IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE UNDERGOING SPINE SURGERY UNDER GENERAL ANAESTHESIA: LUNG PROTECTIVE VENTILATION VS STANDARD MECHANICAL VENTILATION

Abstract

INTRODUCTION: Choice of lung protective versus standard mechanical ventilation, remains subject of debate in COPD patients. So, this review aimed to compare the incidence of post operative pulmonary complications in patients with COPD undergoing spine surgery under general anesthesia with LPV versus SMV.

OBJECTIVE: To compare the incidence of post-operative pulmonary complications using lung protective ventilation and standard mechanical ventilation in patients with COPD undergoing spine surgery under general anesthesia.

METHODOLOGY: This RCT has included 80 COPD patients undergoing spine surgery at Mayo Hospital, Lahore. Patients were randomly assigned using lottery method to group A (LPV) and group B (SMV). Standard pre-induction, induction, and maintenance anesthesia protocols were followed in both groups. ABGs were checked after 2 hours of ventilation. Postoperatively, patients were monitored in PACU. Supplemental oxygen and noninvasive measures were provided as needed. Incidence of Post operative pulmonary complications were recorded. Data analysis was performed using SPSS v26. Chi-square tests were used to compare incidence of Post operative pulmonary complications between groups, with significance threshold of p ≤ 0.05.

RESULTS: In group A less patients developed Post operative pulmonary complications as compared to group B i.e. 5(87.5%) vs 13(32.5%), p=0.03. Group A patients had utilized supplemental oxygen less vs group B i.e. 7.5% vs 27.5% (p=0.01), NRM 2.5% vs 15% (p=0.04), and CPAP 2.5% vs 12.5% (p=0.08). Group A vs B excessive cough; 5% vs 25% (p=0.01), 2.5% vs 17.5% (p=0.02) bronchospasm, and 2.5% vs 7% (p=0.30) atelectasis. Data stratification with respect to age, female gender and duration of surgery found to be insignificant p>0.05. Data stratification with respect to male gender (p=0.02) and smoking (0.05) found to be significant p<0.05.

CONCLUSION: It is concluded that, LPV may significantly reduce the incidence of post-operative pulmonary complications as compared to standard mechanical ventilation in patients with COPD undergoing spine surgery under general anesthesia.