Please use this identifier to cite or link to this item: 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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