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Individualised peri...
Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE) : a randomised controlled trial
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- Ferrando, Carlos (author)
- Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia 46010, Spain.;Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain.
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Soro, Marina (author)
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- Unzueta, Carmen (author)
- Hosp Univ Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain.
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- Suarez-Sipmann, Fernando (author)
- Uppsala universitet,Hedenstiernalaboratoriet,Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain.
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- Canet, Jaume (author)
- Hosp Univ Germans Tries & Pujol, Dept Anesthesiol & Crit Care, Badalona, Spain.
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- Librero, Julian (author)
- REDISSEC, Navarrabiomed Fdn Miguel Servet, Pamplona, Spain.
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- Pozo, Natividad (author)
- Hosp Clin Univ Valencia, INCLIVA Clin Res Inst, Valencia, Spain.
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- Peiro, Salvador (author)
- REDISSEC, CSISP FISABIO, Valencia, Spain.
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- Llombart, Alicia (author)
- Hosp Univ Politecn Fe, IISLAFE Clin Res Inst, Valencia, Spain.
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- Leon, Irene (author)
- Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia 46010, Spain.
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- India, Inmaculada (author)
- Hosp Univ Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain.
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- Aldecoa, Cesar (author)
- Hosp Univ Rio Hortega, Dept Anesthesiol & Crit Care, Valladolid, Spain.
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- Diaz-Cambronero, Oscar (author)
- Hosp Univ Politecn Fe, Dept Anesthesiol & Crit Care, Valencia, Spain.
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- Pestana, David (author)
- Hosp Univ Ramon & Cajal, Dept Anesthesiol & Crit Care, Madrid, Spain.
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- Redondo, Francisco J. (author)
- Hosp Gen Univ Ciudad Real, Dept Anesthesiol & Crit Care, Ciudad Real, Spain.
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- Garutti, Ignacio (author)
- Hosp Gen Univ Gregorio Maranon, Dept Anesthesiol & Crit Care, Madrid, Spain.
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- Balust, Jaume (author)
- Hosp Clin & Prov Univ, Dept Anesthesiol & Crit Care, Barcelona, Spain.
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- Garcia, Jose I. (author)
- 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.
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- Ibanez, Maite (author)
- Hosp Marina Baixa Vila Joiosa, Dept Anesthesiol, Alicante, Spain.
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- Granell, Manuel (author)
- Hosp Gen Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
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- Rodriguez, Aurelio (author)
- Hosp Univ Doctor Negrin, Dept Anesthesiol, Las Palmas Gran Canaria, Spain.
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- Gallego, Lucia (author)
- Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
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- de la Matta, Manuel (author)
- Hosp Univ Virgen Rocio, Dept Anesthesiol & Crit Care, Seville, Spain.
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- Gonzalez, Rafael (author)
- Hosp Univ Leon, Dept Anesthesiol, Leon, Spain.
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- Brunelli, Andrea (author)
- Hosp Univ Germans Tries & Pujol, Dept Anesthesiol & Crit Care, Badalona, Spain.
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Garcia, Javier (author)
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- Rovira, Lucas (author)
- Hosp Manises, Dept Anesthesiol, Valencia, Spain.
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- Barrios, Francisco (author)
- Hosp Principe Asturias Madrid, Dept Anesthesiol & Crit Care, Madrid, Spain.
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- Torres, Vicente (author)
- Hosp Son Espases, Dept Anesthesiol & Crit Care, Palma de Mallorca, Spain.
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- Hernandez, Samuel (author)
- Hosp NS Candelaria, Dept Anesthesiol, Santa Cruz de Tenerife, Spain.
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Gracia, Estefania (author)
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- Gine, Marta (author)
- Hosp Univ Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain.
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- Garcia, Maria (author)
- Hosp Univ Rio Hortega, Dept Anesthesiol & Crit Care, Valladolid, Spain.
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Garcia, Nuria (author)
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Miguel, Lisset (author)
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Sanchez, Sergio (author)
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Pineiro, Patricia (author)
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- Pujol, Roger (author)
- Hosp Clin & Prov Univ, Dept Anesthesiol & Crit Care, Barcelona, Spain.
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- Garcia-del-Valle, Santiago (author)
- Hosp Fdn Alcorcon, Dept Anesthesiol & Crit Care, Alcorcon, Spain.
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- Valdivia, Jose (author)
- Hosp Marina Baixa Vila Joiosa, Dept Anesthesiol, Alicante, Spain.
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- Hernandez, Maria J. (author)
- Hosp Gen Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
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- Padron, Oto (author)
- Hosp Univ Doctor Negrin, Dept Anesthesiol, Las Palmas Gran Canaria, Spain.
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- Colas, Ana (author)
- Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
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- Puig, Jaume (author)
- Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia 46010, Spain.
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- Azparren, Gonzalo (author)
- Hosp Univ Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain.
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- Tusman, Gerardo (author)
- Hosp Privado Comunidad Mar Plata, Dept Anesthesiol, Mar Del Plata, Buenos Aires, Argentina.
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- Villar, Jesus (author)
- Hosp Univ Doctor Negrin, Multidisciplinary Organ Dysfunct Evaluat Res Netw, Las Palmas Gran Canaria, Spain.
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- Belda, Javier (author)
- Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia 46010, Spain.;Univ Valencia, Dept Surg, Valencia, Spain.
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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)
- ELSEVIER SCI LTD, 2018
- 2018
- English.
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In: The Lancet Respiratory Medicine. - : ELSEVIER SCI LTD. - 2213-2600 .- 2213-2619. ; 6:3, s. 193-203
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Subject headings
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- 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Lungmedicin och allergi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Respiratory Medicine and Allergy (hsv//eng)
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Ferrando, Carlos
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Soro, Marina
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Unzueta, Carmen
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Suarez-Sipmann, ...
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Canet, Jaume
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Librero, Julian
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Pozo, Natividad
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Peiro, Salvador
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Llombart, Alicia
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Leon, Irene
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India, Inmaculad ...
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Aldecoa, Cesar
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Diaz-Cambronero, ...
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Pestana, David
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Redondo, Francis ...
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Garutti, Ignacio
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Balust, Jaume
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Garcia, Jose I.
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Ibanez, Maite
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Granell, Manuel
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Rodriguez, Aurel ...
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Gallego, Lucia
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de la Matta, Man ...
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Gonzalez, Rafael
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Brunelli, Andrea
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Garcia, Javier
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Rovira, Lucas
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Barrios, Francis ...
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Torres, Vicente
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Hernandez, Samue ...
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Gracia, Estefani ...
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Gine, Marta
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Garcia, Maria
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Garcia, Nuria
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Miguel, Lisset
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Sanchez, Sergio
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Pineiro, Patrici ...
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Pujol, Roger
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Garcia-del-Valle ...
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Valdivia, Jose
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Hernandez, Maria ...
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Padron, Oto
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Colas, Ana
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Puig, Jaume
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Azparren, Gonzal ...
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Tusman, Gerardo
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Villar, Jesus
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Belda, Javier
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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- MEDICAL AND HEALTH SCIENCES
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The Lancet Respi ...
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Uppsala University