The Potential Dangers of Recruitment Maneuvers During One Lung Ventilation Surgery.

Autor: Kidane B; Section of Thoracic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Division of Thoracic Surgery, Western University, London, Ontario, Canada. Electronic address: b.kidane@mail.utoronto.ca., Palma DC; Division of Thoracic Surgery, Western University, London, Ontario, Canada., Badner NH; Department of Anesthesiology, Western University, London, Ontario, Canada., Hamilton M; Division of Thoracic Surgery, Western University, London, Ontario, Canada., Leydier L; Section of Thoracic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada., Fortin D; Division of Thoracic Surgery, Western University, London, Ontario, Canada; Division of Critical Care Medicine, Department of Medicine, Western University, London, Ontario, Canada., Inculet RI; Division of Thoracic Surgery, Western University, London, Ontario, Canada., Malthaner RA; Division of Thoracic Surgery, Western University, London, Ontario, Canada.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2019 Feb; Vol. 234, pp. 178-183. Date of Electronic Publication: 2018 Oct 11.
DOI: 10.1016/j.jss.2018.09.024
Abstrakt: Background: Existing evidence regarding lung-protective ventilation (LPV) during one-lung ventilation (OLV) focuses on surrogate outcomes. Our objective was to assess whether an LPV protocol during OLV surgery is associated with reduced respiratory complications.
Materials and Methods: This was a matched control retrospective cohort study of patients undergoing pulmonary resection at a tertiary Canadian hospital. The experimental group (n = 50) was derived from primary data of two crossover RCTs, which utilized protocolized LPV strategies with varying levels of positive end-expiratory pressure and recruitment maneuvers. The control group was drawn from a prospectively maintained database; these patients received conventional nonprotocolized ventilation (2000-2010). Each experimental group patient was matched 1:1 with a control group patient with respect to clinically relevant variables (age, sex, diagnosis, smoking status, cardiovascular disease status, comorbidity, BMI, preoperative forced expiratory volume in 1 s, surgery type). Major respiratory complications were defined as composite of acute respiratory distress syndrome, need for new positive-pressure ventilation, and atelectasis requiring bronchoscopy. Paired and unpaired statistical tests were used.
Results: Patients appeared well matched. Major respiratory complications occurred in 8% (n = 4) and 2% (n = 1) of patients in experimental and control groups, respectively (P = 0.50). There was a trend toward increased mortality (4 versus 0, P = 0.06) with protocolized LPV. The patients who died had respiratory complications; one had acute respiratory distress syndrome and two had profound hypoxemia.
Conclusions: There was a nonsignificant trend toward increased mortality with LPV during OLV. Although limited by a small sample size, our findings identify a potential danger to excessive recruitment maneuvers. Larger studies, with clinically important outcomes are needed to better define the risk/benefit trade-offs for LPV during OLV.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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