1. Comparative effects of variable versus conventional volume-controlled one-lung ventilation on gas exchange and respiratory system mechanics in thoracic surgery patients: A randomized controlled clinical trial.
- Author
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Wittenstein J, Huhle R, Mutschke AK, Piorko S, Kramer T, Dorfinger L, Tempel F, Jäger M, Schweigert M, Mauer R, Koch T, Richter T, Scharffenberg M, and Gama de Abreu M
- Subjects
- Humans, Male, Female, Middle Aged, Aged, Positive-Pressure Respiration methods, Positive-Pressure Respiration adverse effects, Anesthesia, General methods, Respiration, Artificial methods, Oxygen blood, Oxygen administration & dosage, One-Lung Ventilation methods, One-Lung Ventilation adverse effects, Thoracic Surgical Procedures adverse effects, Thoracic Surgical Procedures methods, Pulmonary Gas Exchange, Tidal Volume, Respiratory Mechanics
- Abstract
Background: Mechanical ventilation with variable tidal volumes (V-VCV) has the potential to improve lung function during general anesthesia. We tested the hypothesis that V-VCV compared to conventional volume-controlled ventilation (C-VCV) would improve intraoperative arterial oxygenation and respiratory system mechanics in patients undergoing thoracic surgery under one-lung ventilation (OLV)., Methods: Patients were randomized to V-VCV (n = 39) or C-VCV (n = 39). During OLV tidal volume of 5 mL/kg predicted body weight (PBW) was used. Both groups were ventilated with a positive end-expiratory pressure (PEEP) of 5 cm H
2 O, inspiration to expiration ratio (I:E) of 1:1 (during OLV) and 1:2 during two-lung ventilation, the respiratory rate (RR) titrated to arterial pH, inspiratory peak-pressure ≤ 40 cm H2 O and an inspiratory oxygen fraction of 1.0., Results: Seventy-five out of 78 Patients completed the trial and were analyzed (dropouts were excluded). The partial pressure of arterial oxygen (PaO2 ) 20 min after the start of OLV did not differ among groups (V-VCV: 25.8 ± 14.6 kPa vs C-VCV: 27.2 ± 15.3 kPa; mean difference [95% CI]: 1.3 [-8.2, 5.5], P = 0.700). Furthermore, intraoperative gas exchange, intraoperative adverse events, need for rescue maneuvers due to desaturation and hypercapnia, incidence of postoperative pulmonary and extra-pulmonary complications, and hospital free days at day 30 after surgery did not differ between groups., Conclusions: In thoracic surgery patients under OLV, V-VCV did not improve oxygenation or respiratory system mechanics compared to C-VCV. Ethical Committee: EK 420092019., Trial Registration: at the German Clinical Trials Register: DRKS00022202 (16.06.2020)., Competing Interests: Declaration of competing interest M.G.A. received consultation fees from Dräger, Ambu, GE Healthcare, and ZOLL. M.G.A. and T.K. were granted a patent on variable pressure support ventilation and might indirectly benefit from this publication. All other authors have disclosed that they do not have any conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)- Published
- 2024
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