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  • Ferrando, CarlosInst Invest Biomed August Pi & Sunyer, Barcelona, Spain.;Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain.;Inst Invest August Pi & Sunyer, Hosp Clin, Dept Anesthesiol & Crit Care, Barcelona 08036, Spain. (författare)

Individualised, perioperative open-lung ventilation strategy during one-lung ventilation (iPROVE-OLV) : a multicentre, randomised, controlled clinical trial

  • Artikel/kapitelEngelska2024

Förlag, utgivningsår, omfång ...

  • Elsevier,2024
  • printrdacarrier

Nummerbeteckningar

  • LIBRIS-ID:oai:DiVA.org:uu-533311
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-533311URI
  • https://doi.org/10.1016/S2213-2600(23)00346-6DOI

Kompletterande språkuppgifter

  • Språk:engelska
  • Sammanfattning på:engelska

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Klassifikation

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

Anmärkningar

  • 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 H2O of end-inspiratory pressure followed by individualised positive end-expiratory pressure (PEEP) titrated to best respiratory system compliance, and individualised postoperative respiratory support with high-flow oxygen therapy. Participants allocated to standard lungprotective ventilation received combined intraoperative 4 cm H2O of PEEP and postoperative conventional oxygen therapy. The primary outcome was a composite of severe postoperative pulmonary complications within the first 7 postoperative days, including atelectasis requiring bronchoscopy, severe respiratory failure, contralateral pneumothorax, early extubation failure (rescue with continuous positive airway pressure, non-invasive ventilation, invasive mechanical ventilation, or reintubation), acute respiratory distress syndrome, pulmonary infection, bronchopleural fistula, and pleural empyema. Due to trial setting, data obtained in the operating and postoperative rooms for routine monitoring were not blinded. At 24 h, data were acquired by an investigator blinded to group allocation. All analyses were performed on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, NCT03182062, and is complete. 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 center dot 39 [95% CI 0 center dot 28 to 0 center dot 56]), with an absolute risk difference of -9 center dot 23 (95% CI -12 center dot 55 to -5 center dot 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. Copyright (c) 2023 Elsevier Ltd. All rights reserved.

Ämnesord och genrebeteckningar

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

  • Carraminana, AlbertHosp Clin Barcelona, Dept Anesthesiol & Crit Care, Barcelona, Spain. (författare)
  • Pineiro, Patricia (författare)
  • Mirabella, LuciaUniv Foggia, Dept Med & Surg Sci, Foggia, Italy. (författare)
  • Spadaro, SavinoAzienda Osped Univ Ferrara, Dept Anesthesiol & Crit Care, I-44100 Ferrara, Italy. (författare)
  • Libero, JulianNavarrabiomed CHN UPNA, Red Invest Serv Sanitarios & Cronicidad REDISSEC, IdiSNA, Pamplona, Spain. (författare)
  • Ramasco, FernandoHosp Univ Princesa, Dept Anesthesiol & Crit Care, Madrid, Spain. (författare)
  • Scaramuzzo, GaetanoAzienda Osped Univ Ferrara, Dept Anesthesiol & Crit Care, I-44100 Ferrara, Italy. (författare)
  • Cervantes, OriolHosp Badalona Germans Trias & Pujol, Dept Anesthesiol & Crit Care, Barcelona, Spain. (författare)
  • Garutti, IgnacioHosp Univ Gregorio Maranon, Dept Anesthesiol & Crit Care, Madrid, Spain. (författare)
  • Parera, AnaHosp Univ St Creu & St Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain. (författare)
  • Argilaga, MartaHosp Univ St Creu & St Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain. (författare)
  • Herranz, GraciaHosp Univ St Creu & St Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain. (författare)
  • Unzueta, CarmenHosp Univ St Creu & St Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain. (författare)
  • Vives, MarcHosp Univ Josep Trueta, Dept Anesthesiol & Crit Care, Girona, Spain. (författare)
  • Regi, KevinHosp Univ Josep Trueta, Dept Anesthesiol & Crit Care, Girona, Spain. (författare)
  • Costa-Reverte, MartaHosp Univ Bellvitge, Dept Anesthesiol & Crit Care, Barcelona, Spain. (författare)
  • Leal, Maria SonsolesHosp Rivera Povisa, Vigo, Spain. (författare)
  • Garcia, Esther (författare)
  • Rodriguez-Perez, AurelioHosp Univ Gran Canaria Dr Negrin, Dept Anesthesiol & Crit Care, Gran Canarias, Spain. (författare)
  • Farina, RobertoHosp Univ Gran Canaria Dr Negrin, Dept Anesthesiol & Crit Care, Gran Canarias, Spain. (författare)
  • Cabrera, SergioHosp Univ Gran Canaria Dr Negrin, Dept Anesthesiol & Crit Care, Gran Canarias, Spain. (författare)
  • Guerra, ElisabethHosp Univ Princesa, Dept Anesthesiol & Crit Care, Madrid, Spain.;Hosp Univ Gran Canaria Dr Negrin, Dept Anesthesiol & Crit Care, Gran Canarias, Spain. (författare)
  • Gallego-Ligorit, LuciaHosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.;Inst Invest Sanitaria Aragon IIS Aragon, Zaragoza, Spain. (författare)
  • Herrero-Izquierdo, AlbaHosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.;Inst Invest Sanitaria Aragon IIS Aragon, Zaragoza, Spain. (författare)
  • Valles-Torres, J.Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.;Inst Invest Sanitaria Aragon IIS Aragon, Zaragoza, Spain. (författare)
  • Ramos, SilviaHosp Univ Gregorio Maranon, Dept Anesthesiol & Crit Care, Madrid, Spain. (författare)
  • Lopez-Herrera, DanielHosp Univ Virgen Rocio, Dept Anesthesiol & Crit Care, Seville, Spain. (författare)
  • Matta, Manuel De LaHosp Univ Virgen Rocio, Dept Anesthesiol & Crit Care, Seville, Spain. (författare)
  • Gokhan, SertcakacilarBakirkoy Dr Sadi Konuk Training & Res Hosp, Dept Anesthesiol & Crit Care, Istanbul, Turkiye.;Outcomes Res Consortium, Cleveland, OH USA. (författare)
  • Kucur, EvrimBakirkoy Dr Sadi Konuk Training & Res Hosp, Dept Anesthesiol & Crit Care, Istanbul, Turkiye. (författare)
  • Mugarra, AnaHosp Clin Univ Valencia, Dept Anesthesiol & Crit Care, Valencia, Spain. (författare)
  • Soro, MarinaHosp Clin Univ Valencia, Dept Anesthesiol & Crit Care, Valencia, Spain. (författare)
  • Garcia, LauraHosp Clin Univ Valencia, Dept Anesthesiol & Crit Care, Valencia, Spain. (författare)
  • Sastre, Jose AlfonsoHosp Univ Salamanca, Dept Anesthesiol & Crit Care, Salamanca 37007, Spain. (författare)
  • Aguirre, PilarHosp Alvaro Cunqueiro, Dept Anesthesiol & Crit Care, Vigo, Spain. (författare)
  • Salazar, Claudia JimenaHosp Univ Ntra Sra Candelaria, Dept Syst Anesthesiol & Crit Care, Santa Cruz De Tenerife, Spain. (författare)
  • Ramos, Maria CarolinaHosp Univ Ntra Sra Candelaria, Dept Syst Anesthesiol & Crit Care, Santa Cruz De Tenerife, Spain. (författare)
  • Morocho, Diego RolandoHosp Eugenio Espejo, Dept Anesthesiol, Quito, Ecuador. (författare)
  • Trespalacios, RamonHosp Univ Cent Asturias, Dept Anesthesiol & Crit Care, Oviedo, Spain. (författare)
  • Ezequiel-Fernandez, FelixHosp Univ Cent Asturias, Dept Anesthesiol & Crit Care, Oviedo, Spain. (författare)
  • Lamanna, AngellaUniv Foggia, Dept Med & Surg Sci, Foggia, Italy. (författare)
  • Cantatore, Leonarda PiaUniv Foggia, Dept Med & Surg Sci, Foggia, Italy. (författare)
  • Laforgia, DonatoUniv Foggia, Dept Med & Surg Sci, Foggia, Italy. (författare)
  • Bellas, SoledadHosp Univ Fdn Jimenez Diaz, Dept Anesthesiol & Crit Care, Madrid, Spain. (författare)
  • Lopez, CarlosHosp Univ Marques de Valdecilla, Dept Anesthesiol & Crit Care, Santander, Spain. (författare)
  • Navarro-Ripoll, RicardHosp Clin Barcelona, Dept Anesthesiol & Crit Care, Barcelona, Spain. (författare)
  • Martinez, SamiraHosp Clin Barcelona, Dept Anesthesiol & Crit Care, Barcelona, Spain. (författare)
  • Vallverdu, JordiHosp Clin Barcelona, Dept Anesthesiol & Crit Care, Barcelona, Spain. (författare)
  • Jacas, AdrianaHosp Clin Barcelona, Dept Anesthesiol & Crit Care, Barcelona, Spain. (författare)
  • Yepes-Temino, Maria JoseClin Univ Navarra, Dept Anesthesiol & Crit Care, Pamplona, Spain. (författare)
  • Belda, Francisco Javier (författare)
  • Tusman, GerardoHosp Privado Comunidad Mar Del Plata, Dept Anestesiol, Mar Del Plata, Buenos Aires, Argentina. (författare)
  • Suarez-Sipmann, FernandoUppsala universitet,Hedenstiernalaboratoriet,Inst Salud Carlos III, CIBER Enfermedades Resp CIBERES, Madrid, Spain.(Swepub:uu)fersi946 (författare)
  • Villar, JesusCIBER Enfermedades Resp, Madrid, Spain.;Hosp Univ Dr Negrin, Las Palmas Gran Canaria, Spain.;St Michaels Hosp, Li Ka Shing Knowledge Inst Med Sci, Toronto, ON, Canada. (författare)
  • Inst Invest Biomed August Pi & Sunyer, Barcelona, Spain.;Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain.;Inst Invest August Pi & Sunyer, Hosp Clin, Dept Anesthesiol & Crit Care, Barcelona 08036, Spain.Hosp Clin Barcelona, Dept Anesthesiol & Crit Care, Barcelona, Spain. (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:The Lancet Respiratory Medicine: Elsevier12:3, s. 195-2062213-26002213-2619

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