الفهرس 
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Abstract
General anesthesia along with mechanical ventilation are essential in surgical procedures. However, adverse respiratory effects as reduction of functional residual capacity and development of atelectasis begin as soon as the patient loses consciousness(2).
Abdominal procedures have repeatedly been shown to be high risk for development of postoperative pulmonary complications (PPCs). Laparotomy with an upper abdominal incision may have up to 15 times the risk of a PPC compared with a lower abdominal incision(6).
Morbidity, mortality and length of hospital stay are increased by PPCs that increase the health care cost.(8) Anesthetists and surgeons should therefore be aware of patients at risk and adopt preventative measures that may reduce morbidity, mortality, and the cost of a surgical procedure(9).
The concept of lung-protective ventilation is well established in patients with acute lung injury. However, data establishing the beneficial results of intraoperative lung-protective ventilation are increasing(11). It involves consideration of tidal volume (VT), level of positive end expiratory pressure (PEEP) and use of recruitment maneuver (11).
This study was designed to evaluate the efficacy of RM in addition to lung protective ventilation on postoperative pulmonary complications in patients undergoing upper abdominal surgeries under general anesthesia.
Our aim of this study was to reduce postoperative pulmonary complications in patients undergoing non-laparoscopic upper abdominal surgeries under general anesthesia.
Following approval of Suez Canal University ethical committee, the study was performed on sixty-six patients undergoing non-laparoscopic
Summary
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upper abdominal surgeries under general anesthesia. Patients were randomly assigned into two equal groups; control group that included thirty-three patients received mechanical ventilation with low tidal volumed and fixed PEEP (5 mmHg) without lung recruitment maneuver and recruitment group which included thirty-three patients received mechanical ventilation with low tidal volume and individualized PEEP with stepwise lung recruitment maneuver.
The patient was mechanically ventilated using tidal volume of 8 ml/kg of predicted body weight, respiratory rate of 12 breaths/min and was adjusted to keep normocapnia, FiO2 of 0.4 fresh gas flow 1 liter, inspiratory: expiratory ratio of 1:2, PEEP 5 cmH2O in pressure-controlled volume guaranteed ventilation (PCV-VG) mode.
Lung recruitment was done in recruitment group after induction of anesthesia, using stepwise approach by increasing PEEP in increments of 2 CmH2O every 5 breaths as long as compliance increases.
When compliance started to decrease, PEEP was decreased in 2 cmH2O decrements every 5 breaths until sudden decrease in compliance happens, at this point recruitment maneuver were stopped and PEEP were adjusted to the point 2 CmH2O above the level of sudden decrease in compliance.
Plateau pressure, driving pressure, pulmonary compliance, SpO2, and blood pressure were monitored at each step of RM.
postoperative pulmonary complications during the first seven postoperative days