The authors merged Society of Thoracic Surgeons Database and Multicenter Perioperative Outcomes Group intraoperative data for lung resection procedures using one-lung ventilation across five institutions from 2012 to 2016. They defined one-lung protective ventilation as the combination of both median tidal volume 5 ml/kg or lower predicted body weight and positive end-expiratory pressure 5 cm H2O or greater. The primary outcome was a composite of 30-day major postoperative pulmonary complications.
A total of 3,232 cases were available for analysis. Tidal volumes decreased modestly during the study period (6.7 to 6.0 ml/kg; P < 0.001), and positive end-expiratory pressure increased from 4 to 5 cm H2O (P < 0.001). Despite increasing adoption of a “protective ventilation” strategy (5.7% in 2012 vs. 17.9% in 2016), the prevalence of pulmonary complications did not change significantly (11.4 to 15.7%; P = 0.147). In a propensity score matched cohort (381 matched pairs), protective ventilation (mean tidal volume 6.4 vs. 4.4 ml/kg) was not associated with a reduction in pulmonary complications (adjusted odds ratio, 0.86; 95% CI, 0.56 to 1.32). In an unmatched cohort, the authors were unable to define a specific alternative combination of positive end-expiratory pressure and tidal volume that was associated with decreased risk of pulmonary complications.
In this multicenter retrospective observational analysis of patients undergoing one-lung ventilation during thoracic surgery, the authors did not detect an independent association between a low tidal volume lung-protective ventilation regimen and a composite of postoperative pulmonary complications.
- Lower tidal volume ventilation with moderate positive end-expiratory pressure (PEEP) compared with higher tidal volumes with low PEEP is associated with fewer pulmonary complications in adult respiratory distress syndrome and in abdominal surgery with two-lung ventilation.
- Fewer studies have assessed optimal ventilation strategies for thoracic surgery with one-lung ventilation. Optimal lung protective strategies for one-lung ventilation are undefined.
- This five-center retrospective observational study evaluated records from 3,232 thoracic surgical patients who underwent one-lung ventilation for pneumonectomies, bilobectomies, single lobectomies, segmentectomies, or wedge resections.
- Patients with tidal volumes 5 ml/kg or lower and PEEP greater than 5 cm H2O did not have significantly different 30-day adverse pulmonary outcomes compared with patients not ventilated with this strategy.
- Higher mechanical ventilation driving pressures were not associated with composite 30-day adverse pulmonary outcome.
- The protective ventilation regimen tested was not associated with decreased pulmonary complications.