One-lung ventilation with fixed and variable tidal volumes on oxygenation and pulmonary outcomes: A randomized trial.

Autor: Szamos K; University of Debrecen, Department of Anesthesiology and Intensive Care, Debrecen, Hungary., Balla B; University of Debrecen, Department of Anesthesiology and Intensive Care, Debrecen, Hungary., Pálóczi B; University of Debrecen, Department of Anesthesiology and Intensive Care, Debrecen, Hungary., Enyedi A; University of Debrecen, Institute of Surgery, Department of Thoracic Surgery, Debrecen, Hungary., Sessler DI; Outcomes Research Consortium, Cleveland, OH, USA; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA., Fülesdi B; University of Debrecen, Department of Anesthesiology and Intensive Care, Debrecen, Hungary; Outcomes Research Consortium, Cleveland, OH, USA., Végh T; University of Debrecen, Department of Anesthesiology and Intensive Care, Debrecen, Hungary; Outcomes Research Consortium, Cleveland, OH, USA. Electronic address: veghdr@med.unideb.hu.
Jazyk: angličtina
Zdroj: Journal of clinical anesthesia [J Clin Anesth] 2024 Aug; Vol. 95, pp. 111465. Date of Electronic Publication: 2024 Apr 06.
DOI: 10.1016/j.jclinane.2024.111465
Abstrakt: Objective: Test the hypothesis that one-lung ventilation with variable tidal volume improves intraoperative oxygenation and reduces postoperative pulmonary complications after lung resection.
Background: Constant tidal volume and respiratory rate ventilation can lead to atelectasis. Animal and human ARDS studies indicate that oxygenation improves with variable tidal volumes. Since one-lung ventilation shares characteristics with ARDS, we tested the hypothesis that one-lung ventilation with variable tidal volume improves intraoperative oxygenation and reduces postoperative pulmonary complications after lung resection.
Design: Randomized trial.
Setting: Operating rooms and a post-anesthesia care unit.
Patients: Adults having elective open or video-assisted thoracoscopic lung resection surgery with general anesthesia were randomly assigned to intraoperative ventilation with fixed (n = 70) or with variable (n = 70) tidal volumes.
Interventions: Patients assigned to fixed ventilation had a tidal volume of 6 ml/kgPBW, whereas those assigned to variable ventilation had tidal volumes ranging from 6 ml/kg PBW ± 33% which varied randomly at 5-min intervals.
Measurements: The primary outcome was intraoperative oxygenation; secondary outcomes were postoperative pulmonary complications, mortality within 90 days of surgery, heart rate, and SpO 2 /FiO 2 ratio.
Results: Data from 128 patients were analyzed with 65 assigned to fixed-tidal volume ventilation and 63 to variable-tidal volume ventilation. The time-weighted average PaO 2 during one-lung ventilation was 176 (86) mmHg in patients ventilated with fixed-tidal volume and 147 (72) mmHg in the patients ventilated with variable-tidal volume, a difference that was statistically significant (p < 0.01) but less than our pre-defined clinically meaningful threshold of 50 mmHg. At least one composite complication occurred in 11 (17%) of patients ventilated with variable-tidal volume and in 17 (26%) of patients assigned to fixed-tidal volume ventilation, with a relative risk of 0.67 (95% CI 0.34-1.31, p = 0.24). Atelectasis in the ventilated lung was less common with variable-tidal volumes (4.7%) than fixed-tidal volumes (20%) in the initial three postoperative days, with a relative risk of 0.24 (95% CI 0.01-0.8, p = 0.02), but there were no significant late postoperative differences. No other secondary outcomes were both statistically significant and clinically meaningful.
Conclusion: One-lung ventilation with variable tidal volume does not meaningfully improve intraoperative oxygenation, and does not reduce postoperative pulmonary complications.
Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest. None of the authors received compensation to perform this study.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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