Lung protective ventilation strategy to reduce postoperative pulmonary complications (PPCs) in patients undergoing robot-assisted laparoscopic radical cystectomy for bladder cancer: A randomized double blinded clinical trial - 14/05/21
, Hong Xie, Prof, MD, PhD a, ⁎ Abstract |
Study objective |
To evaluate the effects of ventilation with low tidal volume and positive end-expiratory pressure (PEEP) on postoperative pulmonary complications in patients undergoing robot-assisted laparoscopic radical cystectomy (RARC) for bladder cancer.
Design |
A prospective randomized double-blinded study.
Setting |
A single center trial in a comprehensive tertiary hospital from January 2017 to January 2019.
Patients |
A total of 258 patients undergoing RARC for bladder cancer.
Interventions |
Patients were randomly assigned to receive either lung-protective ventilation (LPV group) [tidal volume 6 ml/ kg predicated body weight (PBW) + PEEP 7 cmH2O] or nonprotective ventilation (control group) (tidal volume 9 ml/ kg PBW without PEEP) during anesthesia.
Measurements |
The primary outcome was the occurrence of postoperative pulmonary complications (PPCs) during the first 90 days after surgery. The secondary outcomes were extubation time, oxygenation index (OI) after extubation and at postoperative day 1 in blood gas.
Main results |
The incidence of PPCs at postoperative day1, 2 and 3 were lower in LPV group [26.8% vs. 47.2%, odds ratio (OR) 0.41, 95% confidence interval (CI), 0.24–0.69, P = 0.0007, 21.3% vs. 43.3%, OR 0.36, 95% CI, 0.20–0.61, P = 0.0002, 14.2% vs. 27.5%, OR0.43, 95%CI, 0.23–0.82, P = 0.0087, respectively], while no differences were observed at day 7 and 28 (3.9% vs. 9.4%, P = 0.0788, 0% vs. 1.6%, P = 0.4980, respectively). No PPCs were observed at postoperative day 90 in both groups. Furthermore, immediately after extubating and at postoperative day 1, OI was significantly higher in LPV group compared with control group [390(337–467) vs. 343(303–420), P = 0.0005, 406.7(73.0) vs. 425.5(74.7), P = 0.0440, respectively]. Patients in LPV group had a significant shorter extubation time after operation compared with control group [38(33–54) vs. 35(25–46), P = 0.0012].
Conclusion |
LPV combining low tidal volume and PEEP during anesthesia for RARC may decrease the incidence of postoperative pulmonary complications.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Postoperative pulmonary complications are major complications after robot-assisted laparoscopic radical cystectomy in patients with bladder cancer. |
• | Lung-protective ventilation strategy which refers to the use of low tidal volumes and positive end-expiratory pressure has been an important principle in the management of patients with acute lung injury in intensive care unit. |
• | Compared with traditional large tidal volume, Lung-protective ventilation strategy reduced the incidence of postoperative pulmonary complications. |
• | Lung-protective ventilation strategy also improved lung oxygenation and shortened the extubated time after operation for patients with bladder cancer. |
Keywords : Low tidal volume, Positive end-expiratory pressure, Postoperative pulmonary complications, Robot-assisted laparoscopic radical cystectomy, Lung protective ventilation
Plan
Vol 71
Article 110156- août 2021 Retour au numéro
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