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http://hdl.handle.net/10553/70885
Title: | The Effects of an Open-Lung Approach During One-Lung Ventilation on Postoperative Pulmonary Complications and Driving Pressure: A Descriptive, Multicenter National Study | Authors: | Belda, Javier Ferrando, Carlos Garutti, Ignacio Pozo, Natividad Soro, Marina Suarez-Sipmann, Fernando Tusman, Gerardo Unzueta, Carmen Villar, Jesus Bermejo, Silvia Callejo, Angel Coves, Silvia Gallego-Ligorit, Lucía Granell, Manuel Jiménez, Maria J. Lluch, Aitana Martínez, Jesus A. de la Matta, Manuel Planas, Antonio Aguirre, Pilar Rodríguez Pérez, Aurelio Eduardo Sastre, José A. Arocas, Blanca Bárcena, Elizabeth Belmonte, Luis Carbonell, José Carrizo, Juan Charco, Pedro Cuervo, Javier Del Río, Elena Florea, Raluca Gutiérrez, Andrea Jurado, Ana Lascorz, Laura Navarro, Jose Manuel Martínez, Sara Monleon, Berta Parra, María J. Pérez, Sara Sancho, Laura Serralta, Ferran Villena, Abigail Cruz, Patricia de la Gala, Francisco Olmedilla, Luis Piñeiro, Patricia Sánchez-Pedrosa, Guillermo Alday, Enrique Muñoz, Manuel Ramasco, Fernando Díaz, Rubén Parera, Ana Cabrera, Sergio Guerra, Elizabeth Morales, Laura Gallart, Lluís Pérez, Alejandro Calderón, Adriana Guerrero, María Kadaoui, Salah Din Levstek, Meta Real, María I. Pintor, Jesús Barrado, P. Cotera, I. Izquierdo, B. Lacosta, L. Molinos, I. Rubio, B. Puértolas, M. Sanjuan-Villareal, A. Vallés-Torres, J. Tres, Eva Viguera, Laura Biosca, Elena Broseta, Ana Hernández, Javier Morales, Javier Navarro-Ripoll, Ricard Femenia, Xisco Mínguez, Laura López, Amparo Esteve, Isabel Llácer, Eva Blanco, Luisa Ceresuela, Reyes Orallo, Maria A. Pereira, Denis Prieto, María P. Otero, Teresa |
UNESCO Clasification: | 3207 Patología | Keywords: | Positive end-expiratorypressure One-lungventilation Postoperative pulmonary complications Driving pressure |
Issue Date: | 2018 | Journal: | Journal of Cardiothoracic and Vascular Anesthesia | Abstract: | Objective: Thoracic surgical procedures are associated with an increased risk of postoperative pulmonary complications (PPCs), which seem to be related directly to intraoperative driving pressure. The authors conducted this study to describe the incidence of PPCs in patients in whom an individualized open-lung approach was applied during one-lung ventilation. Design: This was a prospective, multicenter, national descriptive study. Setting: Thoracic surgery patients undergoing one-lung ventilation. Participants: Eligible participants were included consecutively from October 1, 2016, to September 30, 2017. A total of 690 patients were included. Interventions: An individualized open-lung approach that consisted of an alveolar recruitment maneuver followed by a positive end-expiratory pressure adjusted to best respiratory system compliance was performed in all patients. Measurements and Main Results: Preoperative and intraoperative data were recorded; the primary outcome was a description of the incidence of PPCs in these patients during the first 7 postoperative days. The patients were mainly male, and half of them had a high risk of PPCs (ARISCAT score exceeding 44). Eleven percent of participants developed a PPC within the first postoperative week. The mean open lung positive end-expiratory pressure was 8 ± 3 cmH2O. When compared with pre-open lung approach values, the open-lung approach significantly decreased the driving pressure (14 ± 4 cmH2O v 11 ± 3 cmH2O; p < 0.001) and increased dynamic compliance (30 ± 10 mL/cmH2O v 43 ±15 mL/cmH2O; p < 0.001). Conclusions: The low incidence of PPCs in patients who underwent an open-lung approach during one-lung ventilation compared with that reported for other thoracic surgery series and the decrease in the driving pressure in these patients justify an additional randomized controlled trial to compare the open-lung approach with the standard protective strategy of low tidal volume and low positive end-expiratory pressure. | URI: | http://hdl.handle.net/10553/70885 | ISSN: | 1053-0770 | DOI: | 10.1053/j.jvca.2018.03.028 | Source: | Journal of Cardiothoracic and Vascular Anesthesia [ISSN 1053-0770], v. 32 (6), p. 2665–2672 |
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