Whether Postoperative Mechanical Ventilation Always Mandatory for Patients Suffered of Intraoperative Massive Hemorrhage in Elective Surgery: Arguments and Cases of Single Hospital

D.A Tipisev, E.S. Gorobets, V.E. Gruzdev, M.A. Anisimov, N.B. Borovkova, E.O. Kochkovaya

Russian Oncological Research Center, Ministry of Health of Russian Federation, Moscow

For correspondence: Tipisev Dmitry Anrievich — MD, senior research fellow, Department of Anesthesiology and Intensive care, Russian Oncological Research Center, Ministry of Health of Russian Federation, Moscow; e-mail: dtipisev@mail.ru

For citation: Tipisev DA Gorobets ES, Gruzdev VE, Anisimov MA, Borovkova NB, Kochkovaya EO. Whether Postoperative Mechanical Ventilation is Always Mandatory for Patients Suffered of Intraoperative Massive Hemorrhage in Elective Surgery: Arguments and Cases of Single Hospital. Intensive Care Herald. 2016;4:52–58.

Massive hemorrage (MH) — the life-threatening complication of major cancer surgery that requires urgent measures for prevention of hemorrhagic shock and multiple organ failure. Not uncommon, at the end of surgery procedure the patient suffered of MH gained not sufficient state to be extubated, thus needed in postoperative mechanical ventilation (PMV). Nevertheless, the timely effective treatment and prevention of MH consequences founded on multimodal combined anesthesia/analgesia (epidural analgesia with light sevoflurane of desflurane anesthesia) with other complex measures (i.v. infusions, vasopressors, blood components, etc) may become the basis of patient status stable enough for safe tracheal extubation (TE) on the operation table in some cases. Since the mid 90-ies of the last century, first in cardiac surgery, then in other fields of surgery can be seen the steady tendency towards early TE that tends to achieve good results, both clinical and economic. We suggested the possibility of TE at the end of surgery for 30 patients after the loss of blood volume ³ 70 %. All of them achieved predefined endpoint criteria for secure recovery of spontaneous respiration (SB) despite the duration and extent of traumatic procedures. None of our patients required reintubation postoperatively. 29 patients had been discharged from the hospital. One lethal case occurred for the reason, not associated with the early TE. The objective and subjective reasons as well as risks associated with postoperative MV are discussed. Criteria for safe and successful ET after accomplished MH are suggested. We believe, that even after the intraoperative MH, when the steady patient state condition had been gained, the prolonged MV should be objectively justified.

Keywords: massive hemorrhage, multimodal combined anesthesia, early tracheal extubation

Received: 26.08.2016


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