One-Lung Ventilation and Postoperative Pulmonary Complications After Major Lung Resection Surgery. A Multicenter Randomized Controlled Trial.
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Piccioni Federico, Langiano Nicola, Bignami Elena, Guarnieri Marcello, Proto Paolo, D'Andrea Rocco, Mazzoli Carlo A, Riccardi Ilaria, Bacuzzi Alessandro, Guzzetti Luca, Rossi Irene, Scolletta Sabino, Comi Daniela, Benigni Alberto, Pierconti Federico, Coccia Cecilia, Biscari Matteo, Murzilli Alice, Umari Marzia, Peratoner Caterina, Serra Eugenio, Baldinelli Francesco, Accardo Rosanna, Diana Fernanda, Fasciolo Alessandro, Amodio Riccardo, Ball Lorenzo, Greco Massimiliano, Pelosi Paolo, Della Rocca Giorgio, One-Lung Ventilation Investigators Group (Supplementary Appendix S1)
Аннотация
DESIGN: Multicenter, randomized, single-blind, controlled trial.
SETTING: Sixteen Italian hospitals.
PARTICIPANTS: A total of 880 patients undergoing elective major lung resection.
INTERVENTIONS: Patients were randomized to receive lower tidal volume (LTV group: 4 mL/kg predicted body weight, PEEP of 5 cmH2O, and ARMs) or higher tidal volume (HTL group: 6 mL/kg predicted body weight, no PEEP, and no ARMs). After OLV, until extubation, both groups were ventilated using a tidal volume of 8 mL/kg and a PEEP value of 5 cmH2O. The primary outcome was the incidence of in-hospital ARDS. Secondary outcomes were the in-hospital rate of PPCs, major cardiovascular events, unplanned intensive care unit (ICU) admission, in-hospital mortality, ICU length of stay, and in-hospital length of stay.
MEASUREMENTS AND MAIN RESULTS: ARDS occurred in 3 of 438 patients (0.7%, 95% CI 0.1-2.0) and in 1 of 442 patients (0.2%, 95% CI 0-1.4) in the LTV and HTV group, respectively (Risk ratio: 3.03 95% CI 0.32-29, p = 0.372). Pulmonary complications occurred in 125 of 438 patients (28.5%, 95% CI 24.5-32.9) and in 136 of 442 patients (30.8%, 95% CI 26.6-35.2) in the LTV and HTV group, respectively (risk ratio: 0.93, 95% CI 0.76-1.14, p = 0.507). The incidence of major complications, in-hospital mortality, and unplanned ICU admission, ICU and in-hospital length of stay were comparable in both groups.
CONCLUSIONS: In conclusion, among adult patients undergoing elective lung resection, an OLV with lower tidal volume, PEEP 5 cmH2O, and ARMs and a higher tidal volume strategy resulted in low ARDS incidence and comparable postoperative complications, in-hospital length of stay, and mortality.