Protective Lung Ventilation and Morbidity After Pulmonary Resection: A Propensity Score-Matched Analysis

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Critical Care Medicine

Background:

• Protective lung ventilation (PLV) is often recommended during one-lung ventilation (OLV) in thoracic surgery to minimize pulmonary complications.
• However, evidence on the clinical impact of PLV on pulmonary morbidity after lung resection remains limited.

Purpose of the Study:

• To investigate whether PLV during OLV is associated with reduced incidence of pneumonia and/or acute respiratory distress syndrome (ARDS) after lung resection.
• To compare outcomes between patients receiving PLV (<8 mL/kg tidal volume) and non-PLV (≥8 mL/kg tidal volume) during OLV.

Main Methods:

• Prospective data collection from 1080 patients undergoing pulmonary resection with OLV.
• Patients received intentional crystalloid restriction and mechanical ventilation with peak airway pressure <30 cm H2O.
• Propensity score matching was used to compare PLV and non-PLV groups, with outcomes analyzed by exact logistic regression.

Main Results:

• No significant difference in pneumonia/ARDS incidence between PLV and non-PLV groups in anatomic lung resection (4.1% vs 5.2%).
• No significant difference in pneumonia/ARDS incidence between PLV and non-PLV groups in nonanatomic lung resection (0.9% vs 2.5%).
• Odds ratios for pneumonia/ARDS were 1.29 (anatomic) and 3.00 (nonanatomic) for non-PLV vs PLV.

Conclusions:

• This study found no difference in pneumonia/ARDS incidence between PLV and non-PLV groups during OLV for lung resection.
• Findings suggest a small clinical impact of PLV when fluid restriction and low peak airway pressures are maintained.
• Further randomized trials are necessary to confirm the benefits of small tidal volume strategies during OLV.