INTERVENTIONS
INTERVENTIONS
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PEEP AND TIDAL VOLUME
Patients can be assigned to PEEP values of 5, 8 or 10 cm H2O and tidal volumes of 6, 8 or 10 mL/kg.
Immediately after confirmed tracheal intubation, the ventilator will be set to the assigned values. The assigned PEEP and tidal volume are kept until extubation or transfer to the intensive care unit.
Ventilatory management
Normocapnia is recommended.
Airtrapping should be avoided.
Recruitment maneuvers are discouraged unless there is refractory hypoxia.
Peak inspiratory pressure should be kept below 40 cmH20 and plateau pressures below 35 cmH20. If these airway pressures cannot be lowered by other means, either tidal volume or PEEP can be lowered. This decision is made by the attending physician.
FiO2
Patient can be allocated to FiO2 of 30 % or 80%. Immediately after confirmed tracheal intubation, the FiO2 will be set to the allocated value and maintained until extubation. After extubation, the patients will continue supplemental oxygen therapy corresponding to their allocated FiO2 target for two hours after arrival at PACU (post-anesthesia care unit).
FiO2 30%: Nasal cannula 3 l/min.
FiO2 80%: Nonrebreather mask 15 l/min.
If not extubated the allocated FiO2 is kept on the ventilator until 2 hours after arrival at ICU (intensive care unit).
Oxygen management
During the period of intervention, FiO2 may be increased if the saturation is < 94% or the PaO2 is < 8 kPa.
Postoperative oxygen therapy can be changed if clinical indicated (e.g., severe chronic obstructive pulmonary disease with hypercapnia).
BLOOD PRESSURE
The blood pressure targets will be either a fixed MAP of 60, 70 or 80 mmHg, or 90% of baseline systolic blood pressure (SBP).
The allocated blood pressure target will be used from induction to two hours after arrival in the PACU or ICU.
There will be no protocolized interventions to lower the blood pressure. If a vasopressor is required to maintain the blood pressure target, the blood pressure should be aimed at the allocated blood pressure target (not above).
Blood pressure management
If there is clinical suspicion of hypovolemia, fluid therapy is recommended.
If a vasopressor is required, phenylephrine or norepinephrine are recommended as the first choice.
If patients present with acute illness, e.g., sepsis, we will use the latest available blood pressure before onset of acute illness. If no blood pressure measurement (within 90 days of inclusion) is available, we will use 120 mmHg as baseline SBP.
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