LUNG PROTECTIVE VENTILATION STRATEGIES FOR PATIENTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME IN PACU AN OBSERVATIONAL STUDY

Abstract

Background: Acute Respiratory Distress Syndrome remains a critical postoperative complication, and mechanical ventilation though lifesaving worsen lung injury if not carefully managed. Lung-protective ventilation strategies, which use low tidal volumes, optimal PEEP, and controlled plateau pressures, are well-established in the intensive care setting but understudied in the Post-Anesthesia Care Unit. Objectives: To observe and evaluate the use of lung-protective ventilation strategies in postoperative patients with or at risk for ARDS in the PACU of Lady Reading Hospital, Peshawar, and to assess adherence to established LPV guidelines. Methods: In this observational cross-sectional study, 188 adult surgical patients admitted to the PACU over a four-month period were enrolled via non-probability convenience sampling. Ventilator parameters (tidal volume, PEEP, FiO₂, plateau pressure, mode) and demographic data were recorded using a structured checklist. Data were analyzed descriptively and compared against guideline-based targets for LPV. Results: Among 188 patients, the majority were male (59.6%) with a broad age distribution. Volume-controlled ventilation was used in 50% of patients. Ideal low tidal volumes (≤ 6 mL/kg predicted body weight) were applied in 40.4%, while 28.7% received non-protective volumes (> 8 mL/kg). Moderate PEEP (6–8 cmH₂O) was used in 43.6% of patients, and 65.4% maintained plateau pressures under 30 cmH₂O. Complete adherence to LPV (all three criteria: low tidal volume, plateau pressure <30, PEEP ≥5) was seen only in 30.8% of patients. Conclusion: Lung-protective ventilation is partially implemented in the PACU, with many patients achieving some but not all LPV targets. There is a need for standardized ventilation protocols, ongoing training, and monitoring in the perioperative setting to improve adherence and potentially reduce postoperative pulmonary complications