Author:
Karalapillai Dharshi,Weinberg Laurence,Neto Ary Serpa,Peyton Philip J.,Ellard Louise,Hu Raymond,Pearce Brett,Tan Chong O.,Story David,O’Donnell Mark,Hamilton Patrick,Oughton Chad,Galtieri Jonathan,Wilson Anthony,Liskaser Grace,Balasubramaniam Ajay,Eastwood Glenn,Bellomo Rinaldo,Jones Daryl A.
Abstract
Abstract
Background
We recently reported the results for a large randomized controlled trial of low tidal volume ventilation (LTVV) versus conventional tidal volume (CTVV) during major surgery when positive end expiratory pressure (PEEP) was equal between groups. We found no difference in postoperative pulmonary complications (PPCs) in patients who received LTVV. However, in the subgroup of patients undergoing laparoscopic surgery, LTVV was associated with a numerically lower rate of PPCs after surgery. We aimed to further assess the relationship between LTVV versus CTVV during laparoscopic surgery.
Methods
We conducted a post-hoc analysis of this pre-specified subgroup. All patients received volume-controlled ventilation with an applied PEEP of 5 cmH2O and either LTVV (6 mL/kg predicted body weight [PBW]) or CTVV (10 mL/kg PBW). The primary outcome was the incidence of a composite of PPCs within seven days.
Results
Three hundred twenty-eight patients (27.2%) underwent laparoscopic surgeries, with 158 (48.2%) randomised to LTVV. Fifty two of 157 patients (33.1%) assigned to LTVV and 72 of 169 (42.6%) assigned to conventional tidal volume developed PPCs within 7 days (unadjusted absolute difference, − 9.48 [95% CI, − 19.86 to 1.05]; p = 0.076). After adjusting for pre-specified confounders, the LTVV group had a lower incidence of the primary outcome than patients receiving CTVV (adjusted absolute difference, − 10.36 [95% CI, − 20.52 to − 0.20]; p = 0.046).
Conclusion
In this post-hoc analysis of a large, randomised trial of LTVV we found that during laparoscopic surgeries, LTVV was associated with a significantly reduced PPCs compared to CTVV when PEEP was applied equally between both groups.
Trial registration
Australian and New Zealand Clinical Trials Registry no: 12614000790640.
Publisher
Springer Science and Business Media LLC
Subject
Anesthesiology and Pain Medicine
Reference34 articles.
1. Karalapillai D, Weinberg L, Peyton P, et al. Effect of intraoperative low tidal volume vs conventional tidal volume on postoperative pulmonary complications in patients undergoing major surgery: a randomized clinical trial. JAMA. 2020;324(9):848–58. https://doi.org/10.1001/jama.2020.12866 PMID: 32870298; PMCID: PMC7489812.
2. Futier E, Constantin JM, Paugam-Burtz C, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med. 2013;369:428e37.
3. Choi ES, Oh AY, In CB, Ryu JH, Jeon YT, Kim HG. Effects of recruitment manoeuvre on perioperative pulmonary complications in patients undergoing robotic assisted radical prostatectomy: a randomised single-blinded trial. PLoS One. 2017;12:e0183311.
4. Chugh V, Tyagi A, Das S, Sethi AK. Intraoperative ventilation with lowered tidal volumes in patients of perforation peritonitis: effect on postoperative organ dysfunction and systemic inflammatory mediators. Vol Respiration. 2012;1138.
5. Kuzkov VV, Rodionova LN, Ilyina YY, et al. Protective ventilation improves gas exchange, reduces incidence of atelectases, and affects metabolic response in major pancreatoduodenal surgery. Front Med (Lausanne). 2016;3:66.