Protective lung ventilation and morbidity after pulmonary resection: A propensity score-matched analysis Journal Article

Authors: Amar, D.; Zhang, H.; Pedoto, A.; Desiderio, D. P.; Shi, W.; Tan, K. S.
Article Title: Protective lung ventilation and morbidity after pulmonary resection: A propensity score-matched analysis
Abstract: BACKGROUND: Protective lung ventilation (PLV) during one-lung ventilation (OLV) for thoracic surgery is frequently recommended to reduce pulmonary complications. However, limited outcome data exist on whether PLV use during OLV is associated with less clinically relevant pulmonary morbidity after lung resection. METHODS: Intraoperative data were prospectively collected in 1080 patients undergoing pulmonary resection with OLV, intentional crystalloid restriction, and mechanical ventilation to maintain inspiratory peak airway pressure <30 cm H2O. Other ventilator settings and all aspects of anesthetic management were at the discretion of the anesthesia care team. We defined PLV and non-PLV as <8 or ≥8 mL/kg (predicted body weight) mean tidal volume. The primary outcome was the occurrence of pneumonia and/or acute respiratory distress syndrome (ARDS). Propensity score matching was used to generate PLV and non-PLV groups with comparable characteristics. Associations between outcomes and PLV status were analyzed by exact logistic regression, with matching as cluster in the anatomic and nonanatomic lung resection cohorts. RESULTS: In the propensity score-matched analysis, the incidence of pneumonia and/or ARDS among patients who had an anatomic lung resection was 9/172 (5.2%) in the non-PLV compared to the PLV group 7/172 (4.1%; odds ratio, 1.29; 95% confidence interval, 0.48-3.45, P=.62). The incidence of pneumonia and/or ARDS in patients who underwent nonanatomic resection was 3/118 (2.5%) in the non-PLV compared to the PLV group, 1/118 (0.9%; odds ratio, 3.00; 95% confidence interval, 0.31-28.84, P=.34). CONCLUSIONS: In this prospective observational study, we found no differences in the incidence of pneumonia and/or ARDS between patients undergoing lung resection with tidal volumes <8 or ≥8 mL/kg. Our data suggest that when fluid restriction and peak airway pressures are limited, the clinical impact of PLV in this patient population is small. Future randomized trials are needed to better understand the benefits of a small tidal volume strategy during OLV on clinically important outcomes. © 2017 International Anesthesia Research Society.
Journal Title: Anesthesia and Analgesia
Volume: 125
Issue: 1
ISSN: 0003-2999
Publisher: Lippincott Williams & Wilkins  
Date Published: 2017-07-01
Start Page: 190
End Page: 199
Language: English
DOI: 10.1213/ane.0000000000002151
PROVIDER: scopus
PUBMED: 28598916
Notes: Article -- Export Date: 3 July 2017 -- Source: Scopus
Citation Impact
MSK Authors
  1. Alessia C Pedoto
    18 Pedoto
  2. Weiji Shi
    121 Shi
  3. David Amar
    122 Amar
  4. Hao Zhang
    52 Zhang
  5. Kay See   Tan
    116 Tan