Journal of cardiothoracic and vascular anesthesia · 2025
Driving Pressure-Guided Tidal Volume Titration Reduces Lung Injury in Thoracic Surgery With One-Lung Ventilation: A Randomized Clinical Trial.
СтатьяРандомизированное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Yan Yun, Liu Xiaowen, Liu Zhen, Li Zhe, Cai Huamei, Li Weixia, Zhao Jing
Аннотация
OBJECTIVE: The optimal tidal volume for patients undergoing thoracic surgery with one-lung ventilation (OLV) remains unclear. This study aimed to evaluate whether driving pressure-guided tidal volume titration could reduce lung injury in these patients.
DESIGN: Prospective, single-center, randomized controlled trial.
SETTING: Single-center academic hospital in China.
PARTICIPANTS: A total of 96 patients undergoing thoracic surgery with OLV.
INTERVENTIONS: Patients were randomly assigned to either the driving pressure-guided tidal volume group (n = 46) or the control group (n = 50). In the control group, tidal volume was set at 8 mL/kg of predicted body weight (PBW) during OLV. In the driving pressure-guided group, tidal volume was adjusted to maintain a driving pressure between 8 and 10 cm H2O, with modifications within 4 to 8 mL/kg PBW during OLV.
MEASUREMENTS AND MAIN RESULTS: The primary outcome was the concentration of interleukin 6 (IL-6) in the dependent lung following OLV. The tidal volume in the driving pressure-guided group was 4.65 [4.23-5.65] mL/kg at 15 minutes and 4.58 [4.27-5.41] mL/kg at 45 minutes of OLV. The concentration of IL-6 in the dependent lung after OLV was significantly lower in the driving pressure group (5.31 [3.62]) compared to the control group (7.37 [5.21]) (mean difference: -0.46 [-0.86 to -0.05] cm H2O; p = 0.025). There were no significant differences between groups in the incidence of postoperative pulmonary complications or in the oxygenation index 45 minutes after the start of OLV.
CONCLUSIONS: Driving pressure-guided tidal volume titration significantly reduces IL-6 levels in bronchoalveolar lavage fluid from the dependent lung following OLV in patients undergoing thoracic surgery, compared to conventional ventilation using 8 mL/kg PBW.
DESIGN: Prospective, single-center, randomized controlled trial.
SETTING: Single-center academic hospital in China.
PARTICIPANTS: A total of 96 patients undergoing thoracic surgery with OLV.
INTERVENTIONS: Patients were randomly assigned to either the driving pressure-guided tidal volume group (n = 46) or the control group (n = 50). In the control group, tidal volume was set at 8 mL/kg of predicted body weight (PBW) during OLV. In the driving pressure-guided group, tidal volume was adjusted to maintain a driving pressure between 8 and 10 cm H2O, with modifications within 4 to 8 mL/kg PBW during OLV.
MEASUREMENTS AND MAIN RESULTS: The primary outcome was the concentration of interleukin 6 (IL-6) in the dependent lung following OLV. The tidal volume in the driving pressure-guided group was 4.65 [4.23-5.65] mL/kg at 15 minutes and 4.58 [4.27-5.41] mL/kg at 45 minutes of OLV. The concentration of IL-6 in the dependent lung after OLV was significantly lower in the driving pressure group (5.31 [3.62]) compared to the control group (7.37 [5.21]) (mean difference: -0.46 [-0.86 to -0.05] cm H2O; p = 0.025). There were no significant differences between groups in the incidence of postoperative pulmonary complications or in the oxygenation index 45 minutes after the start of OLV.
CONCLUSIONS: Driving pressure-guided tidal volume titration significantly reduces IL-6 levels in bronchoalveolar lavage fluid from the dependent lung following OLV in patients undergoing thoracic surgery, compared to conventional ventilation using 8 mL/kg PBW.