Article ; Online: Individualised, perioperative open-lung ventilation strategy during one-lung ventilation (iPROVE-OLV): a multicentre, randomised, controlled clinical trial.
The Lancet. Respiratory medicine
2023 Volume 12, Issue 3, Page(s) 195–206
Abstract: Background: 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) ...
| Abstract | Background: 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 H Findings: Between Sept 11, 2018, and June 14, 2022, we enrolled 1380 patients, of whom 1308 eligible patients (670 [434 male, 233 female, and three with missing data] assigned to iOLA and 638 [395 male, 237 female, and six with missing data] to standard lung-protective ventilation) were included in the final analysis. The proportion of patients with the composite outcome of severe postoperative pulmonary complications within the first 7 postoperative days was lower in the iOLA group compared with the standard lung-protective ventilation group (40 [6%] vs 97 [15%], relative risk 0·39 [95% CI 0·28 to 0·56]), with an absolute risk difference of -9·23 (95% CI -12·55 to -5·92). Recruitment manoeuvre-related adverse events were reported in five patients. Interpretation: Among patients subjected to lung resection under one-lung ventilation, iOLA was associated with a reduced risk of severe postoperative pulmonary complications when compared with conventional lung-protective ventilation. Funding: Instituto de Salud Carlos III and the European Regional Development Funds. |
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| MeSH term(s) | Adult ; Humans ; Female ; Male ; Adolescent ; One-Lung Ventilation ; Respiration ; Continuous Positive Airway Pressure ; Lung/surgery ; Oxygen |
| Chemical Substances | Oxygen (S88TT14065) |
| Language | English |
| Publishing date | 2023-12-05 |
| Publishing country | England |
| Document type | Randomized Controlled Trial ; Multicenter Study ; Journal Article |
| ZDB-ID | 2686754-0 |
| ISSN | 2213-2619 ; 2213-2600 |
| ISSN (online) | 2213-2619 |
| ISSN | 2213-2600 |
| DOI | 10.1016/S2213-2600(23)00346-6 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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