| Does a protective ventilation strategy reduce the risk of pulmonary complications after lung cancer surgery?: a randomized controlled trial. | |
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MedLine Citation:
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PMID: 20829341 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Protective ventilation strategy has been shown to reduce ventilator-induced lung injury in patients with ARDS. In this study, we questioned whether protective ventilatory settings would attenuate lung impairment during one-lung ventilation (OLV) compared with conventional ventilation in patients undergoing lung resection surgery. METHODS: One hundred patients with American Society of Anesthesiology physical status 1 to 2 who were scheduled for an elective lobectomy were enrolled in the study. During OLV, two different ventilation strategies were compared. The conventional strategy (CV group, n=50) consisted of FIO2 1.0, tidal volume (Vt) 10 mL/kg, zero end-expiratory pressure, and volume-controlled ventilation, whereas the protective strategy (PV group, n=50) consisted of FIO2 0.5, Vt 6 mL/kg, positive end-expiratory pressure 5 cm H2O, and pressure-controlled ventilation. The composite primary end point included PaO2/FIO2<300 mm Hg and/or the presence of newly developed lung lesions (lung infiltration and atelectasis) within 72 h of the operation. To monitor safety during OLV, oxygen saturation by pulse oximeter (SpO2), PaCO2, and peak inspiratory pressure (PIP) were repeatedly measured. RESULTS: During OLV, although 58% of the PV group needed elevated FIO2 to maintain an SpO2>95%, PIP was significantly lower than in the CV group, whereas the mean PaCO2 values remained at 35 to 40 mm Hg in both groups. Importantly, in the PV group, the incidence of the primary end point of pulmonary dysfunction was significantly lower than in the CV group (incidence of PaO2/FIO2<300 mm Hg, lung infiltration, or atelectasis: 4% vs 22%, P<.05). CONCLUSION: Compared with the traditional large Vt and volume-controlled ventilation, the application of small Vt and PEEP through pressure-controlled ventilation was associated with a lower incidence of postoperative lung dysfunction and satisfactory gas exchange. Trial registry: Australian New Zealand Clinical Trials Registry; No.: ACTRN12609000861257; URL: www.anzctr.org.au. |
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Authors:
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Mikyung Yang; Hyun Joo Ahn; Kwhanmien Kim; Jie Ae Kim; Chin A Yi; Myung Joo Kim; Hyo Jin Kim |
Publication Detail:
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Type: Journal Article; Randomized Controlled Trial Date: 2010-09-09 |
Journal Detail:
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Title: Chest Volume: 139 ISSN: 1931-3543 ISO Abbreviation: Chest Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-03-02 Completed Date: 2011-04-21 Revised Date: 2012-01-17 |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: United States |
Other Details:
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Languages: eng Pagination: 530-7 Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Gu, Seoul, Korea, 135-710. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Female Humans Intermittent Positive-Pressure Breathing Lung Neoplasms / surgery* Male Middle Aged New Zealand Pneumonectomy / methods* Positive-Pressure Respiration Postoperative Complications / epidemiology*, prevention & control Respiration, Artificial / instrumentation*, methods* Risk Factors Tidal Volume |
| Comments/Corrections | |
Comment In:
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Chest. 2011 Dec;140(6):1668-9; author reply 1669
[PMID:
22147831
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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