BACKGROUND: Protective ventilation may improve outcomes after major surgery. However, in the context of one-lung ventilation, such a strategy is incompletely defined. The authors hypothesized that a putative one-lung protective ventilation regimen would be independently associated with decreased odds of pulmonary complications after thoracic surgery. METHODS: The authors merged Society of Thoracic Surgeons Database and Multicenter Perioperative Outcomes Group intraoperative data for lung resection procedures using one-lung ventilation across five institutions from 2012 to 2016. They defined one-lung protective ventilation as the combination of both median tidal volume 5 ml/kg or lower predicted body weight and positive end-expiratory pressure 5 cm H2O or greater. The primary outcome was a composite of 30-day major postoperative pulmonary complications. RESULTS: A total of 3,232 cases were available for analysis. Tidal volumes decreased modestly during the study period (6.7 to 6.0 ml/kg; P < 0.001), and positive end-expiratory pressure increased from 4 to 5 cm H2O (P < 0.001). Despite increasing adoption of a "protective ventilation" strategy (5.7% in 2012 vs. 17.9% in 2016), the prevalence of pulmonary complications did not change significantly (11.4 to 15.7%; P = 0.147). In a propensity score matched cohort (381 matched pairs), protective ventilation (mean tidal volume 6.4 vs. 4.4 ml/kg) was not associated with a reduction in pulmonary complications (adjusted odds ratio, 0.86; 95% CI, 0.56 to 1.32). In an unmatched cohort, the authors were unable to define a specific alternative combination of positive end-expiratory pressure and tidal volume that was associated with decreased risk of pulmonary complications. CONCLUSIONS: In this multicenter retrospective observational analysis of patients undergoing one-lung ventilation during thoracic surgery, the authors did not detect an independent association between a low tidal volume lung-protective ventilation regimen and a composite of postoperative pulmonary complications.
BACKGROUND: Protective ventilation may improve outcomes after major surgery. However, in the context of one-lung ventilation, such a strategy is incompletely defined. The authors hypothesized that a putative one-lung protective ventilation regimen would be independently associated with decreased odds of pulmonary complications after thoracic surgery. METHODS: The authors merged Society of Thoracic Surgeons Database and Multicenter Perioperative Outcomes Group intraoperative data for lung resection procedures using one-lung ventilation across five institutions from 2012 to 2016. They defined one-lung protective ventilation as the combination of both median tidal volume 5 ml/kg or lower predicted body weight and positive end-expiratory pressure 5 cm H2O or greater. The primary outcome was a composite of 30-day major postoperative pulmonary complications. RESULTS: A total of 3,232 cases were available for analysis. Tidal volumes decreased modestly during the study period (6.7 to 6.0 ml/kg; P < 0.001), and positive end-expiratory pressure increased from 4 to 5 cm H2O (P < 0.001). Despite increasing adoption of a "protective ventilation" strategy (5.7% in 2012 vs. 17.9% in 2016), the prevalence of pulmonary complications did not change significantly (11.4 to 15.7%; P = 0.147). In a propensity score matched cohort (381 matched pairs), protective ventilation (mean tidal volume 6.4 vs. 4.4 ml/kg) was not associated with a reduction in pulmonary complications (adjusted odds ratio, 0.86; 95% CI, 0.56 to 1.32). In an unmatched cohort, the authors were unable to define a specific alternative combination of positive end-expiratory pressure and tidal volume that was associated with decreased risk of pulmonary complications. CONCLUSIONS: In this multicenter retrospective observational analysis of patients undergoing one-lung ventilation during thoracic surgery, the authors did not detect an independent association between a low tidal volume lung-protective ventilation regimen and a composite of postoperative pulmonary complications.
Authors: Traves D Crabtree; Henning A Gaissert; Jeffrey P Jacobs; Robert H Habib; Felix G Fernandez Journal: Ann Thorac Surg Date: 2018-09-26 Impact factor: 4.330
Authors: Randal S Blank; Douglas A Colquhoun; Marcel E Durieux; Benjamin D Kozower; Timothy L McMurry; S Patrick Bender; Bhiken I Naik Journal: Anesthesiology Date: 2016-06 Impact factor: 7.892
Authors: Douglas A Colquhoun; Bhiken I Naik; Marcel E Durieux; Amy M Shanks; Sachin Kheterpal; S Patrick Bender; Randal S Blank Journal: Anesth Analg Date: 2018-02 Impact factor: 5.108
Authors: Fabienne D Simonis; Ary Serpa Neto; Jan M Binnekade; Annemarije Braber; Karina C M Bruin; Rogier M Determann; Geert-Jan Goekoop; Jeroen Heidt; Janneke Horn; Gerard Innemee; Evert de Jonge; Nicole P Juffermans; Peter E Spronk; Lotte M Steuten; Pieter Roel Tuinman; Rob B P de Wilde; Marijn Vriends; Marcelo Gama de Abreu; Paolo Pelosi; Marcus J Schultz Journal: JAMA Date: 2018-11-13 Impact factor: 56.272
Authors: Ary Serpa Neto; Sabrine N T Hemmes; Carmen S V Barbas; Martin Beiderlinden; Ana Fernandez-Bustamante; Emmanuel Futier; Ognjen Gajic; Mohamed R El-Tahan; Abdulmohsin A Al Ghamdi; Ersin Günay; Samir Jaber; Serdar Kokulu; Alf Kozian; Marc Licker; Wen-Qian Lin; Andrew D Maslow; Stavros G Memtsoudis; Dinis Reis Miranda; Pierre Moine; Thomas Ng; Domenico Paparella; V Marco Ranieri; Federica Scavonetto; Thomas Schilling; Gabriele Selmo; Paolo Severgnini; Juraj Sprung; Sugantha Sundar; Daniel Talmor; Tanja Treschan; Carmen Unzueta; Toby N Weingarten; Esther K Wolthuis; Hermann Wrigge; Marcelo B P Amato; Eduardo L V Costa; Marcelo Gama de Abreu; Paolo Pelosi; Marcus J Schultz Journal: Lancet Respir Med Date: 2016-03-04 Impact factor: 30.700
Authors: Alexandre Biasi Cavalcanti; Érica Aranha Suzumura; Ligia Nasi Laranjeira; Denise de Moraes Paisani; Lucas Petri Damiani; Helio Penna Guimarães; Edson Renato Romano; Marisa de Moraes Regenga; Luzia Noriko Takahashi Taniguchi; Cassiano Teixeira; Roselaine Pinheiro de Oliveira; Flavia Ribeiro Machado; Fredi Alexander Diaz-Quijano; Meton Soares de Alencar Filho; Israel Silva Maia; Eliana Bernardete Caser; Wilson de Oliveira Filho; Marcos de Carvalho Borges; Priscilla de Aquino Martins; Mirna Matsui; Gustavo Adolfo Ospina-Tascón; Thiago Simões Giancursi; Nelson Dario Giraldo-Ramirez; Silvia Regina Rios Vieira; Maria da Graça Pasquotto de Lima Assef; Mohd Shahnaz Hasan; Wojciech Szczeklik; Fernando Rios; Marcelo Britto Passos Amato; Otávio Berwanger; Carlos Roberto Ribeiro de Carvalho Journal: JAMA Date: 2017-10-10 Impact factor: 56.272