OLV in Thoracic Anesthesia
Trial question
What is the role of one-lung ventilation strategy in adult patients undergoing elective lung resection?
Study design
Multi-center
Single blinded
RCT
Population
Characteristics of study participants
39.0% female
61.0% male
N = 880
880 patients (343 female, 537 male).
Inclusion criteria: adult patients undergoing elective major lung resection.
Key exclusion criteria: pregnancy; pulmonary hypertension; moderate-to-severe cardiac disease; renal failure; neuromuscular disorders.
Interventions
N=438 low tidal volume (tidal volume at 4 mL/kg predicted body weight, PEEP of 5 cmH₂O, and alveolar recruitment maneuvers).
N=442 high tidal volume (tidal volume at 6 mL/kg predicted body weight with no PEEP and no alveolar recruitment maneuvers).
Primary outcome
Postoperative acute respiratory distress syndrome
0.7%
0.2%
0.7 %
0.5 %
0.3 %
0.2 %
0.0 %
Low tidal
volume
High tidal
volume
No significant
difference ↔
No significant difference in postoperative ARDS (0.7% vs. 0.2%; RR 3.03, 95% CI 0.32 to 28.99).
Secondary outcomes
No significant difference in major complications (32.6% vs. 34.2%; RR 0.96, 96% CI 0.79 to 1.15).
No significant difference in death in the hospital (0.5% vs. 0.9%; RR 0.5, 95% CI 0.09 to 2.74).
No significant difference in pulmonary complications (28.5% vs. 30.8%; RR 0.93, 95% CI 0.76 to 1.14).
Conclusion
In adult patients undergoing elective major lung resection, low tidal volume was not superior to high tidal volume with respect to postoperative ARDS.
Reference
Federico Piccioni, Nicola Langiano, Elena Bignami et al. One-Lung Ventilation and Postoperative Pulmonary Complications After Major Lung Resection Surgery. A Multicenter Randomized Controlled Trial. J Cardiothorac Vasc Anesth. 2023 Dec;37(12):2561-2571.
Open reference URL