Individualised, perioperative open-lung ventilation strategy during one-lung ventilation (iPROVE-OLV): a multicentre, randomised, controlled clinical trial
Lancet Respir Med. 2023 Dec 5:S2213-2600(23)00346-6. doi: 10.1016/S2213-2600(23)00346-6. Online ahead of print.ABSTRACTBACKGROUND: It is uncertain whether individualisation of the perioperative open-lung approach (OLA) to ventilation reduces postoperative pulmonary complications in patients undergoing lung resection. We compared a perioperative individualised OLA (iOLA) ventilation strategy with standard lung-protective ventilation in patients undergoing thoracic surgery with one-lung ventilation.METHODS: This multicentre, randomised controlled trial enrolled patients scheduled for open or video-assisted thoracic surgery using one-lung ventilation in 25 participating hospitals in Spain, Italy, Turkey, Egypt, and Ecuador. Eligible adult patients (age ≥18 years) were randomly assigned to receive iOLA or standard lung-protective ventilation. Eligible patients (stratified by centre) were randomly assigned online by local principal investigators, with an allocation ratio of 1:1. Treatment with iOLA included an alveolar recruitment manoeuvre to 40 cm H2O of end-inspiratory pressure followed by individualised positive end-expiratory pressure (PEEP) titrated to best respiratory system compliance, and individualised postoperative respiratory support with high-flow oxygen therapy. Participants allocated to standard lung-protective ventilation received combined intraoperative 4 cm H2O of PEEP and postoperative conventional oxygen therapy. The primary outcome was a composite of severe ...
Source: Respiratory Care - Category: Respiratory Medicine Authors: Carlos Ferrando Albert Carrami ñana Patricia Pi ñeiro Lucia Mirabella Savino Spadaro Juli án Librero Fernando Ramasco Gaetano Scaramuzzo Oriol Cervantes Ignacio Garutti Ana Parera Marta Argilaga Gracia Herranz Carmen Unzueta Marc Vives Kevin Regi Marta Source Type: research