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Non-Intubated Video-Assisted Thoracoscopic Surgery
Published on: May 26, 2023
Postoperative Outcomes Following Prolonged One-Lung Ventilation in Thoracic Surgery in Relation to Intraoperative
Mark Ulrich Gerbershagen1, Mark Schieren2, Jerome Defosse2
1Faculty of Medicine, University of Witten/Herdecke, Herdecke, Germany; Department of Anesthesiology, Cologne-Holweide Hospital, Cologne, Germany.
Journal of Cardiothoracic and Vascular Anesthesia
|July 28, 2026
Summary
Intraoperative ventilation settings like driving pressure (DP) and peak airway pressure (pMax) during one-lung ventilation (OLV) were linked to increased postoperative complications in unadjusted analyses. Adjusted models highlighted patient risk and complexity as primary drivers, not ventilation parameters alone.
Area of Science:
- Anesthesiology and Critical Care Medicine
- Thoracic Surgery
- Respiratory Physiology
Background:
- Prolonged one-lung ventilation (OLV) is crucial for thoracic surgery but can lead to postoperative complications.
- Optimizing intraoperative ventilation strategies is essential to mitigate risks associated with OLV.
- Understanding the impact of specific ventilation parameters on patient outcomes is vital for surgical teams.
Purpose of the Study:
- To investigate the association between intraoperative ventilation parameters and postoperative outcomes in patients undergoing prolonged OLV.
- To identify specific ventilation thresholds that may correlate with increased morbidity and mortality.
- To inform clinical practice regarding ventilation management during OLV.
Main Methods:
- Retrospective multicenter cohort study utilizing the German Thorax Registry.
- Inclusion of 2,026 patients undergoing thoracic surgery with OLV exceeding 60 minutes (2016-2021).
- Analysis of ventilation parameters including driving pressure (DP), peak airway pressure (pMax), positive end-expiratory pressure (PEEP), and tidal volume (TV) per predicted body weight (PBW).
Main Results:
- Higher rates of overall postoperative complications were associated with elevated DP (>20 mbar), pMax (>25 mbar), PEEP (>8 mbar), and TV/PBW (>5 mL/kg) in unadjusted analyses.
- Respiratory complications showed significant associations with DP (>20 mbar), pMax (>25 mbar), and TV (>5 mL/kg PBW).
- In-hospital mortality was linked to DP (>20 mbar), pMax (>25 mbar), PEEP (>8 mbar), and TV (>8 mL/kg PBW), though limited by low event numbers.
Conclusions:
- Unadjusted analyses suggest thresholds for ventilation parameters (DP, pMax, PEEP, TV) and duration are linked to postoperative morbidity and mortality.
- Adjusted models indicate patient risk and case complexity are primary drivers, suggesting potential confounding by indication for higher PEEP.
- Prospective studies are needed to validate these findings and refine ventilation strategies during OLV.
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