Anesthesiology. 2021 Apr 1;134(4):562-576. doi: 10.1097/ALN.0000000000003729.
Protective ventilation may improve outcomes after major surgery. However, in the context of one-lung ventilation, such a strategy is incompletely defined. The authors hypothesized that a putative one-lung protective ventilation regimen would be independently associated with decreased odds of pulmonary complications after thoracic surgery.
The authors merged Society of Thoracic Surgeons Database and Multicenter Perioperative Outcomes Group intraoperative data for lung resection procedures using one-lung ventilation across five institutions from 2012 to 2016. They defined one-lung protective ventilation as the combination of both median tidal volume 5 ml/kg or lower predicted body weight and positive end-expiratory pressure 5 cm H2O or greater. The primary outcome was a composite of 30-day major postoperative pulmonary complications.
A total of 3,232 cases were available for analysis. Tidal volumes decreased modestly during the study period (6.7 to 6.0 ml/kg; P < 0.001), and positive end-expiratory pressure increased from 4 to 5 cm H2O (P < 0.001). Despite increasing adoption of a "protective ventilation" strategy (5.7% in 2012 vs. 17.9% in 2016), the prevalence of pulmonary complications did not change significantly (11.4 to 15.7%; P = 0.147). In a propensity score matched cohort (381 matched pairs), protective ventilation (mean tidal volume 6.4 vs. 4.4 ml/kg) was not associated with a reduction in pulmonary complications (adjusted odds ratio, 0.86; 95% CI, 0.56 to 1.32). In an unmatched cohort, the authors were unable to define a specific alternative combination of positive end-expiratory pressure and tidal volume that was associated with decreased risk of pulmonary complications.
In this multicenter retrospective observational analysis of patients undergoing one-lung ventilation during thoracic surgery, the authors did not detect an independent association between a low tidal volume lung-protective ventilation regimen and a composite of postoperative pulmonary complications.
保护性通气可能改善重大手术后的结果。然而，在单肺通气的情况下，这种策略尚未完全确定。作者假设一种假设的单肺保护性通气方案将与胸外科手术后肺部并发症的几率降低独立相关。
作者合并了胸外科医师学会数据库和多中心围手术期结果组的术中数据，以在 2012 年至 2016 年期间在五家机构使用单肺通气进行肺切除术。他们将单肺保护性通气定义为以下两种情况的组合：中位潮气量为 5ml/kg 或更低的预测体重，呼气末正压为 5cmH2O 或更高。主要结果是 30 天主要术后肺部并发症的综合指标。
共有 3232 例病例可供分析。在研究期间，潮气量略有下降（从 6.7ml/kg 降至 6.0ml/kg；P＜0.001），呼气末正压从 4cmH2O 增加到 5cmH2O（P＜0.001）。尽管“保护性通气”策略的采用率逐渐增加（2012 年为 5.7%，2016 年为 17.9%），但肺部并发症的发生率并未显著变化（从 11.4%到 15.7%；P=0.147）。在倾向评分匹配队列（381 对匹配）中，保护性通气（平均潮气量 6.4ml/kg 与 4.4ml/kg）与肺部并发症减少无关（校正比值比，0.86；95%置信区间，0.56 至 1.32）。在未匹配队列中，作者无法确定呼气末正压和潮气量的特定替代组合与肺部并发症风险降低相关。
在这项对接受单肺通气的胸外科手术患者进行的多中心回顾性观察分析中，作者未发现低潮气量肺保护性通气方案与术后肺部并发症综合指标之间存在独立关联。
