Postoperative Hypoxemia After Dual-Controlled vs Volume-Controlled Ventilation in Lung Surgery
Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved..
BACKGROUND: One-lung ventilation for thoracic surgery represents a challenge due to the risk for hypoxemia and barotrauma. Dual-controlled ventilation (ie, pressure-regulated volume control [PRVC]) may confer improved lung mechanics compared with conventional ventilation (volume-controlled ventilation [VCV]). Our objective was to determine the association between ventilatory mode and pulmonary outcomes after lung resection surgery.
METHODS: A historical cohort (2016-2021) of patients undergoing lung resection surgery was used to identify cases performed with PRVC ventilation (intervention) vs VCV (conventional). Both groups were matched in a 1:1 fashion using propensity scoring based on preoperative oxygen saturation, chronic obstructive pulmonary disease, intraoperative ventilator settings, and surgical approach. Our primary outcome was postoperative hypoxemia (oxygen saturation <92% requiring supplemental oxygen longer than 2 hours). Secondary outcomes included respiratory failure, pneumonia, atelectasis, acute respiratory distress syndrome, pleural effusion, and reintubation. Associations were reported using adjusted odds ratios (aOR).
RESULTS: Of 2107 eligible patients (PRVC = 1587 vs VCV = 520), a total of 774 matched pairs were analyzed (PRVC = 387 vs VCV = 387). The overall incidence of postoperative hypoxemia was 35.5% (95% CI 32.2%-39.0%). Hypoxemia was less likely among patients managed with low tidal volumes (≤6 mL/kg per ideal body weight, aOR 0.73, 95% CI 0.57-0.92, P = .008). No significant association was observed between ventilator mode and postoperative hypoxemia (33.3% in PRVC vs 37.7% in VCV; aOR 0.93, 95% CI 0.71-1.23, P = .627) or secondary pulmonary complications (3.9% in PRVC vs 3.4% in VCV; aOR 0.96, 95% CI 0.47-1.97, P = .909).
CONCLUSIONS: Dual-controlled ventilation was not associated with improved pulmonary outcomes compared with conventional ventilation in lung resection surgery.
| Errataetall: |
CommentIn: Ann Thorac Surg. 2023 Jul;116(1):179-180. - PMID 36841494 |
|---|---|
| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:116 |
|---|---|
| Enthalten in: |
The Annals of thoracic surgery - 116(2023), 1 vom: 04. Juli, Seite 173-179 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Zorrilla-Vaca, Andres [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
|---|
| Anmerkungen: |
Date Completed 26.06.2023 Date Revised 20.11.2023 published: Print-Electronic CommentIn: Ann Thorac Surg. 2023 Jul;116(1):179-180. - PMID 36841494 Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.athoracsur.2022.12.029 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM35119858X |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM35119858X | ||
| 003 | DE-627 | ||
| 005 | 20231226050758.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.athoracsur.2022.12.029 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1170.xml |
| 035 | |a (DE-627)NLM35119858X | ||
| 035 | |a (NLM)36608756 | ||
| 035 | |a (PII)S0003-4975(23)00003-6 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Zorrilla-Vaca, Andres |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Postoperative Hypoxemia After Dual-Controlled vs Volume-Controlled Ventilation in Lung Surgery |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 26.06.2023 | ||
| 500 | |a Date Revised 20.11.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Ann Thorac Surg. 2023 Jul;116(1):179-180. - PMID 36841494 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: One-lung ventilation for thoracic surgery represents a challenge due to the risk for hypoxemia and barotrauma. Dual-controlled ventilation (ie, pressure-regulated volume control [PRVC]) may confer improved lung mechanics compared with conventional ventilation (volume-controlled ventilation [VCV]). Our objective was to determine the association between ventilatory mode and pulmonary outcomes after lung resection surgery | ||
| 520 | |a METHODS: A historical cohort (2016-2021) of patients undergoing lung resection surgery was used to identify cases performed with PRVC ventilation (intervention) vs VCV (conventional). Both groups were matched in a 1:1 fashion using propensity scoring based on preoperative oxygen saturation, chronic obstructive pulmonary disease, intraoperative ventilator settings, and surgical approach. Our primary outcome was postoperative hypoxemia (oxygen saturation <92% requiring supplemental oxygen longer than 2 hours). Secondary outcomes included respiratory failure, pneumonia, atelectasis, acute respiratory distress syndrome, pleural effusion, and reintubation. Associations were reported using adjusted odds ratios (aOR) | ||
| 520 | |a RESULTS: Of 2107 eligible patients (PRVC = 1587 vs VCV = 520), a total of 774 matched pairs were analyzed (PRVC = 387 vs VCV = 387). The overall incidence of postoperative hypoxemia was 35.5% (95% CI 32.2%-39.0%). Hypoxemia was less likely among patients managed with low tidal volumes (≤6 mL/kg per ideal body weight, aOR 0.73, 95% CI 0.57-0.92, P = .008). No significant association was observed between ventilator mode and postoperative hypoxemia (33.3% in PRVC vs 37.7% in VCV; aOR 0.93, 95% CI 0.71-1.23, P = .627) or secondary pulmonary complications (3.9% in PRVC vs 3.4% in VCV; aOR 0.96, 95% CI 0.47-1.97, P = .909) | ||
| 520 | |a CONCLUSIONS: Dual-controlled ventilation was not associated with improved pulmonary outcomes compared with conventional ventilation in lung resection surgery | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Grant, Michael C |e verfasserin |4 aut | |
| 700 | 1 | |a Rehman, Muhammad |e verfasserin |4 aut | |
| 700 | 1 | |a Sarin, Pankaj |e verfasserin |4 aut | |
| 700 | 1 | |a Varelmann, Dirk |e verfasserin |4 aut | |
| 700 | 1 | |a Urman, Richard D |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t The Annals of thoracic surgery |d 1965 |g 116(2023), 1 vom: 04. Juli, Seite 173-179 |w (DE-627)NLM000026689 |x 1552-6259 |7 nnns |
| 773 | 1 | 8 | |g volume:116 |g year:2023 |g number:1 |g day:04 |g month:07 |g pages:173-179 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.athoracsur.2022.12.029 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 116 |j 2023 |e 1 |b 04 |c 07 |h 173-179 | ||