One-lung ventilation with fixed and variable tidal volumes on oxygenation and pulmonary outcomes: A randomized trial - 25/04/24
Abstract |
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 SpO2/FiO2 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 PaO2 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.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Variable tidal volume ventilation improves oxygenation in animals and humans with acute respiratory distress syndrome. |
• | We compared oxygenation and pulmonary complications in patients randomized to one-lung ventilation with variable or fixed tidal volumes |
• | Ventilation with variable tidal volume did not improve oxygenation or reduce postoperative pulmonary complications. |
Keywords : Thoracic anesthesia, One-lung ventilation, Tidal volume, Postoperative pulmonary complications, Intraoperative oxygenation, Variable ventilation
Plan
Vol 95
Article 111465- août 2024 Retour au numéro
Article précédent
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