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<p>Protective ventilation reduces ventilator-induced acute lung injury postoperatively; however, the optimal strategy for one-lung ventilation (OLV) remains unclear. This study compared three protective ventilation strategies with a postoperative partial pressure of oxygen (PaO<sub>2</sub>)/fraction of inspired oxygen (FiO<sub>2</sub>) ratio to reduce the incidence of immediate postoperative pulmonary complications (PPCs) in patients undergoing lung resection surgery. Eighty-seven patients with ASA physical status I–III requiring OLV for lung resection surgery were randomized into three groups according to the applied ventilation strategies: low tidal volume (V<sub>T</sub>) of 4&#xa0;mL/kg of predicted body weight (PBW) (LV group), medium V<sub>T</sub> of 6&#xa0;mL/kg of PBW (MV group), and high V<sub>T</sub> of 8&#xa0;mL/kg of PBW (HV group). All patients received 5 cmH<sub>2</sub>O of positive end-expiratory pressure (PEEP). The primary outcome was the mean difference of PaO<sub>2</sub>/FiO<sub>2</sub> ratio after surgery. The radiologic findings of acute lung injuries were also evaluated. The incidence of immediate PPCs was determined by PaO<sub>2</sub>/FiO<sub>2</sub> ratio of &lt; 300&#xa0;mmHg and/or newly developed radiological findings within 72&#xa0;h after surgery. The MV group showed the highest PaO<sub>2</sub>/FiO<sub>2</sub> ratio at 6&#xa0;h postoperatively (<i>P</i> = 0.010). There were no significant among-group differences in radiological findings in 3 postoperative days. The MV group showed the lowest incidence of immediate PPCs among the three groups (<i>P</i> = 0.007). During OLV in lung resection surgery, protective ventilation at a V<sub>T</sub> of 6&#xa0;mL/kg with PEEP of 5 cmH<sub>2</sub>O may achieve a higher postoperative PaO<sub>2</sub>/FiO<sub>2</sub> ratio, reducing the incidence of immediate PPCs.</p>

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An optimal protective ventilation strategy in lung resection surgery: a prospective, single-center, three-arm randomized controlled trial

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年1月21日

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  • Seihee Min,
  • Susie Yoon,
  • Hyun Woo Choe,
  • Haesun Jung,
  • Jeong-Hwa Seo,
  • Jae-Hyon Bahk

摘要

Protective ventilation reduces ventilator-induced acute lung injury postoperatively; however, the optimal strategy for one-lung ventilation (OLV) remains unclear. This study compared three protective ventilation strategies with a postoperative partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio to reduce the incidence of immediate postoperative pulmonary complications (PPCs) in patients undergoing lung resection surgery. Eighty-seven patients with ASA physical status I–III requiring OLV for lung resection surgery were randomized into three groups according to the applied ventilation strategies: low tidal volume (VT) of 4 mL/kg of predicted body weight (PBW) (LV group), medium VT of 6 mL/kg of PBW (MV group), and high VT of 8 mL/kg of PBW (HV group). All patients received 5 cmH2O of positive end-expiratory pressure (PEEP). The primary outcome was the mean difference of PaO2/FiO2 ratio after surgery. The radiologic findings of acute lung injuries were also evaluated. The incidence of immediate PPCs was determined by PaO2/FiO2 ratio of < 300 mmHg and/or newly developed radiological findings within 72 h after surgery. The MV group showed the highest PaO2/FiO2 ratio at 6 h postoperatively (P = 0.010). There were no significant among-group differences in radiological findings in 3 postoperative days. The MV group showed the lowest incidence of immediate PPCs among the three groups (P = 0.007). During OLV in lung resection surgery, protective ventilation at a VT of 6 mL/kg with PEEP of 5 cmH2O may achieve a higher postoperative PaO2/FiO2 ratio, reducing the incidence of immediate PPCs.