An optimal protective ventilation strategy in lung resection surgery: A prospective, single- center, 3-arm randomized controlled trial

Abstract To establish an optimal strategy for one-lung ventilation (OLV), we compared 3 ventilation strategies for avoiding postoperative pulmonary complications (PPCs). Eighty-seven patients requiring OLV for elective thoracic surgery were enrolled and allocated to 3 groups according to ventilation strategies: VT of 4 ml kg-1 of predicted body weight (PBW) (n=29, low volume [LV] group); VT of 6 ml kg-1 of PBW (n=29, medium volume [MV] group); and VT of 8 ml kg-1 of PBW (n=29, high volume [HV] group). All groups were ventilated at PEEP of 5 cmH2O. The primary outcomes included the incidence of PPCs, defined as PaO2/FiO2<300 mmHg, and/or newly developed lung lesions, including infiltration and atelectasis, within 3 days postoperatively. The MV group showed the lowest incidence of PPCs among the LV, MV, and HV groups (12/26 [30.8%] vs 8/29 [20.5%] vs 19/27 [48.7%], P=0.006, respectively). The LV and MV groups revealed significantly higher PaO2/FiO2 ratio than the HV group 6 hours after surgery (P=0.024 and P=0.016, respectively). There were no differences in ventilator-induced lung lesions among the 3 groups. During OLV, protective ventilation at VT of 6 ml kg-1 with PEEP of 5 cmH2O may attain higher postoperative PaO2/FiO2 ratio and lower incidence of PPCs. Registry number of ClnicalTrials.gov: NCT03234621