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Sökning: WFRF:(Belda Francisco J.) > (2018) > Individualised peri...

  • Ferrando, CarlosHosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia 46010, Spain.;Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain. (författare)

Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE) : a randomised controlled trial

  • Artikel/kapitelEngelska2018

Förlag, utgivningsår, omfång ...

  • ELSEVIER SCI LTD,2018
  • printrdacarrier

Nummerbeteckningar

  • LIBRIS-ID:oai:DiVA.org:uu-350497
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-350497URI
  • https://doi.org/10.1016/S2213-2600(18)30024-9DOI

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  • Språk:engelska
  • Sammanfattning på:engelska

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  • Ämneskategori:ref swepub-contenttype
  • Ämneskategori:art swepub-publicationtype

Anmärkningar

  • Background The effects of individualised perioperative lung-protective ventilation (based on the open-lung approach [OLA]) on postoperative complications is unknown. We aimed to investigate the effects of intraoperative and postoperative ventilatory management in patients scheduled for abdominal surgery, compared with standard protective ventilation. Methods We did this prospective, multicentre, randomised controlled trial in 21 teaching hospitals in Spain. We enrolled patients who were aged 18 years or older, were scheduled to have abdominal surgery with an expected time of longer than 2 h, had intermediate-to-high-risk of developing postoperative pulmonary complications, and who had a body-mass index less than 35 kg/m(2). Patients were randomly assigned (1: 1: 1: 1) online to receive one of four lung-protective ventilation strategies using low tidal volume plus positive end-expiratory pressure (PEEP): open-lung approach (OLA)-iCPAP (individualised intraoperative ventilation [individualised PEEP after a lung recruitment manoeuvre] plus individualised postoperative continuous positive airway pressure [CPAP]), OLA-CPAP (intraoperative individualised ventilation plus postoperative CPAP), STD-CPAP (standard intraoperative ventilation plus postoperative CPAP), or STD-O-2 (standard intraoperative ventilation plus standard postoperative oxygen therapy). Patients were masked to treatment allocation. Investigators were not masked in the operating and postoperative rooms; after 24 h, data were given to a second investigator who was masked to allocations. The primary outcome was a composite of pulmonary and systemic complications during the first 7 postoperative days. We did the primary analysis using the modified intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT02158923. Findings Between Jan 2, 2015, and May 18, 2016, we enrolled 1012 eligible patients. Data were available for 967 patients, whom we included in the final analysis. Risk of pulmonary and systemic complications did not differ for patients in OLA-iCPAP (110 [46%] of 241, relative risk 0.89 [95% CI 0.74-1.07; p=0.25]), OLA-CPAP (111 [47%] of 238, 0.91 [0.76-1.09; p=0.35]), or STD-CPAP groups (118 [48%] of 244, 0.95 [0.80-1.14; p=0.65]) when compared with patients in the STD-O-2 group (125 [51%] of 244). Intraoperatively, PEEP was increased in 69 (14%) of patients in the standard perioperative ventilation groups because of hypoxaemia, and no patients from either of the OLA groups required rescue manoeuvres. Interpretation In patients who have major abdominal surgery, the different perioperative open lung approaches tested in this study did not reduce the risk of postoperative complications when compared with standard lung-protective mechanical ventilation.

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Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Soro, Marina (författare)
  • Unzueta, CarmenHosp Univ Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain. (författare)
  • Suarez-Sipmann, FernandoUppsala universitet,Hedenstiernalaboratoriet,Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain.(Swepub:uu)fersi946 (författare)
  • Canet, JaumeHosp Univ Germans Tries & Pujol, Dept Anesthesiol & Crit Care, Badalona, Spain. (författare)
  • Librero, JulianREDISSEC, Navarrabiomed Fdn Miguel Servet, Pamplona, Spain. (författare)
  • Pozo, NatividadHosp Clin Univ Valencia, INCLIVA Clin Res Inst, Valencia, Spain. (författare)
  • Peiro, SalvadorREDISSEC, CSISP FISABIO, Valencia, Spain. (författare)
  • Llombart, AliciaHosp Univ Politecn Fe, IISLAFE Clin Res Inst, Valencia, Spain. (författare)
  • Leon, IreneHosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia 46010, Spain. (författare)
  • India, InmaculadaHosp Univ Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain. (författare)
  • Aldecoa, CesarHosp Univ Rio Hortega, Dept Anesthesiol & Crit Care, Valladolid, Spain. (författare)
  • Diaz-Cambronero, OscarHosp Univ Politecn Fe, Dept Anesthesiol & Crit Care, Valencia, Spain. (författare)
  • Pestana, DavidHosp Univ Ramon & Cajal, Dept Anesthesiol & Crit Care, Madrid, Spain. (författare)
  • Redondo, Francisco J.Hosp Gen Univ Ciudad Real, Dept Anesthesiol & Crit Care, Ciudad Real, Spain. (författare)
  • Garutti, IgnacioHosp Gen Univ Gregorio Maranon, Dept Anesthesiol & Crit Care, Madrid, Spain. (författare)
  • Balust, JaumeHosp Clin & Prov Univ, Dept Anesthesiol & Crit Care, Barcelona, Spain. (författare)
  • Garcia, Jose I.Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia 46010, Spain.;Hosp Univ Politecn Fe, Dept Anesthesiol & Crit Care, Valencia, Spain.;Hosp Fdn Alcorcon, Dept Anesthesiol & Crit Care, Alcorcon, Spain.;Hosp Univ Puerta Hierro, Dept Anesthesiol & Crit Care, Madrid, Spain. (författare)
  • Ibanez, MaiteHosp Marina Baixa Vila Joiosa, Dept Anesthesiol, Alicante, Spain. (författare)
  • Granell, ManuelHosp Gen Univ, Dept Anesthesiol & Crit Care, Valencia, Spain. (författare)
  • Rodriguez, AurelioHosp Univ Doctor Negrin, Dept Anesthesiol, Las Palmas Gran Canaria, Spain. (författare)
  • Gallego, LuciaHosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain. (författare)
  • de la Matta, ManuelHosp Univ Virgen Rocio, Dept Anesthesiol & Crit Care, Seville, Spain. (författare)
  • Gonzalez, RafaelHosp Univ Leon, Dept Anesthesiol, Leon, Spain. (författare)
  • Brunelli, AndreaHosp Univ Germans Tries & Pujol, Dept Anesthesiol & Crit Care, Badalona, Spain. (författare)
  • Garcia, Javier (författare)
  • Rovira, LucasHosp Manises, Dept Anesthesiol, Valencia, Spain. (författare)
  • Barrios, FranciscoHosp Principe Asturias Madrid, Dept Anesthesiol & Crit Care, Madrid, Spain. (författare)
  • Torres, VicenteHosp Son Espases, Dept Anesthesiol & Crit Care, Palma de Mallorca, Spain. (författare)
  • Hernandez, SamuelHosp NS Candelaria, Dept Anesthesiol, Santa Cruz de Tenerife, Spain. (författare)
  • Gracia, Estefania (författare)
  • Gine, MartaHosp Univ Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain. (författare)
  • Garcia, MariaHosp Univ Rio Hortega, Dept Anesthesiol & Crit Care, Valladolid, Spain. (författare)
  • Garcia, Nuria (författare)
  • Miguel, Lisset (författare)
  • Sanchez, Sergio (författare)
  • Pineiro, Patricia (författare)
  • Pujol, RogerHosp Clin & Prov Univ, Dept Anesthesiol & Crit Care, Barcelona, Spain. (författare)
  • Garcia-del-Valle, SantiagoHosp Fdn Alcorcon, Dept Anesthesiol & Crit Care, Alcorcon, Spain. (författare)
  • Valdivia, JoseHosp Marina Baixa Vila Joiosa, Dept Anesthesiol, Alicante, Spain. (författare)
  • Hernandez, Maria J.Hosp Gen Univ, Dept Anesthesiol & Crit Care, Valencia, Spain. (författare)
  • Padron, OtoHosp Univ Doctor Negrin, Dept Anesthesiol, Las Palmas Gran Canaria, Spain. (författare)
  • Colas, AnaHosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain. (författare)
  • Puig, JaumeHosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia 46010, Spain. (författare)
  • Azparren, GonzaloHosp Univ Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain. (författare)
  • Tusman, GerardoHosp Privado Comunidad Mar Plata, Dept Anesthesiol, Mar Del Plata, Buenos Aires, Argentina. (författare)
  • Villar, JesusHosp Univ Doctor Negrin, Multidisciplinary Organ Dysfunct Evaluat Res Netw, Las Palmas Gran Canaria, Spain. (författare)
  • Belda, JavierHosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia 46010, Spain.;Univ Valencia, Dept Surg, Valencia, Spain. (författare)
  • Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia 46010, Spain.;Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain.Hosp Univ Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain. (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:The Lancet Respiratory Medicine: ELSEVIER SCI LTD6:3, s. 193-2032213-26002213-2619

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