@article{aa111127545e479b88c30aa2a17d8a23,
title = "A Lower Tidal Volume Regimen during One-lung Ventilation for Lung Resection Surgery Is Not Associated with Reduced Postoperative Pulmonary Complications",
abstract = "Background: Protective ventilation may improve outcomes after major surgery. However, in the context of one-lung ventilation, such a strategy is incompletely defined. The authors hypothesized that a putative one-lung protective ventilation regimen would be independently associated with decreased odds of pulmonary complications after thoracic surgery. Methods: 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. Results: 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. Conclusions: 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. ",
author = "Colquhoun, {Douglas A.} and Leis, {Aleda M.} and Shanks, {Amy M.} and Mathis, {Michael R.} and Naik, {Bhiken I.} and Durieux, {Marcel E.} and Sachin Kheterpal and Pace, {Nathan L.} and Popescu, {Wanda M.} and Schonberger, {Robert B.} and Kozower, {Benjamin D.} and Walters, {Dustin M.} and Blasberg, {Justin D.} and Chang, {Andrew C.} and Aziz, {Michael F.} and Izumi Harukuni and Tieu, {Brandon H.} and Blank, {Randal S.}",
note = "Funding Information: Dr. Colquhoun declares research grant support paid to the institution from Merck & Co., Inc. (Kenilworth, New Jersey),unrelated to the current work.Dr.Kheterpal declares research support paid to the institution from Merck & Co., Inc., Becton Dickinson (Franklin Lakes, New Jersey), BCBS of Michigan (Detroit, Michigan), and Apple, Inc. (Cupertino, California), all unrelated to the current work. Dr. Chang declares travel reimbursement from the American Board of Thoracic Surgery (Chicago,Illinois),expert witness fees from defendant attorneys, and peer review services/reimbursement from the Department of Defense (Washington, D.C.), all unrelated to the current work. Dr. Schonberger declares research grant support paid to the institution from Merck & Co., Inc., unrelated to the current work. Dr. Schonberger reports having an equity stake in Johnson and Johnson (New Brunswick, New Jersey) unrelated to the current work. Dr. Blank declares research support paid to the institution from the Association of University Anesthesiologists (San Francisco, California) unrelated to the presented work.The other authors declare no competing interests. Funding Information: Research reported in this publication was supported by the National Institute for General Medical Sciences of the National Institutes of Health (Bethesda, Maryland) under award No.T32GM103730 (to Dr. Colquhoun) and by the National Heart, Lung and Blood Institute of the National Institutes of Health under award No. K01HL141701 (to Dr. Mathis). Additional funding is attributed to the participating institutions. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: {\textcopyright} 2021, the American Society of Anesthesiologists, Inc. All Rights Reserved.",
year = "2021",
doi = "10.1097/ALN.0000000000003729",
language = "English",
pages = "562--576",
journal = "Anesthesiology",
issn = "0003-3022",
}