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One-Lung Ventilation and Postoperative Pulmonary Complications After Major Lung Resection Surgery. A Multicenter
Federico Piccioni1, Nicola Langiano2, Elena Bignami3
1Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Journal of Cardiothoracic and Vascular Anesthesia
|September 20, 2023
Summary
A lung ventilation strategy using low tidal volume, PEEP, and recruitment maneuvers did not significantly reduce ARDS or complications in lung surgery patients. Both strategies showed similar outcomes for ARDS, pulmonary complications, and mortality.
Area of Science:
- Anesthesiology
- Thoracic Surgery
- Critical Care Medicine
Background:
- The optimal one-lung ventilation (OLV) strategy to minimize postoperative acute respiratory distress syndrome (ARDS) and pulmonary complications (PPCs) after lung resection remains unclear.
- Previous research has not definitively established the benefits of low tidal volume (TV), positive end-expiratory pressure (PEEP), and alveolar recruitment maneuvers (ARMs) during OLV.
Purpose of the Study:
- To compare the effectiveness of an OLV strategy employing low tidal volume (LTV), PEEP, and ARMs against a higher tidal volume (HTV) strategy without PEEP and ARMs.
- To evaluate the incidence of in-hospital ARDS and other postoperative complications in adult patients undergoing major lung resection.
Main Methods:
- A multicenter, randomized, single-blind, controlled trial involving 880 adult patients undergoing elective lung resection.
- Patients were randomized to either an LTV group (4 mL/kg predicted body weight, PEEP 5 cmH2O, ARMs) or an HTV group (6 mL/kg predicted body weight, no PEEP, no ARMs).
- The primary outcome was in-hospital ARDS incidence; secondary outcomes included PPCs, cardiovascular events, ICU admissions, mortality, and length of stay.
Main Results:
- The incidence of ARDS was low and not significantly different between the LTV (0.7%) and HTV (0.2%) groups (p=0.372).
- Pulmonary complications occurred in 28.5% of the LTV group and 30.8% of the HTV group, with no significant difference (p=0.507).
- Major complications, mortality, ICU admissions, and lengths of stay were comparable between the two ventilation strategies.
Conclusions:
- In adult patients undergoing lung resection, OLV with LTV, PEEP, and ARMs did not lead to a lower incidence of ARDS compared to an HTV strategy.
- Both ventilation strategies resulted in low ARDS incidence and comparable rates of postoperative complications, mortality, and length of hospital stay.
