The results showed a significant reduction in postoperative pulmonary and extrapulmonary complications with the use of lung-protective ventilation. 4, 6 - 10 In 2013, a multicenter randomized clinical trial compared a lung-protective ventilation strategy (6-8 mL/kg predicted body weight of tidal volume, 6-8 cm H 2O of positive end-expiratory pressure, and periodic recruitment maneuvers) with a nonprotective strategy. 5 However, there has been a growing concern that such large tidal volumes may be injurious and contribute to postoperative morbidity when compared with low-tidal-volume ventilation. Quiz Ref ID Intraoperative mechanical ventilation with supraphysiologic tidal volumes has traditionally been applied to prevent hypoxia and atelectasis. 2 According to an international expert panel–based consensus from 2019, prevention of complications is an important therapeutic and economic goal, which may in part be achieved by the optimization of mechanical ventilation. 1 More than 30% of patients undergoing surgery lasting at least 2 hours with general anesthesia and mechanical ventilation may experience postoperative pulmonary complications. More than an estimated 300 million surgical procedures are performed worldwide every year. Trial Registration ANZCTR Identifier: ACTRN12614000790640 There were no significant differences in any of the secondary outcomes.Ĭonclusions and Relevance Among adult patients undergoing major surgery, intraoperative ventilation with low tidal volume compared with conventional tidal volume, with PEEP applied equally between groups, did not significantly reduce pulmonary complications within the first 7 postoperative days. The primary outcome occurred in 231 of 608 patients (38%) in the low tidal volume group compared with 232 of 590 patients (39%) in the conventional tidal volume group (difference, −1.3% risk ratio, 0.97 P = .64). Results Among 1236 patients who were randomized, 1206 (98.9%) completed the trial (mean age, 63.5 years 494 women 681 undergoing abdominal surgery). Secondary outcomes were postoperative pulmonary complications including development of pulmonary embolism, acute respiratory distress syndrome, systemic inflammatory response syndrome, sepsis, acute kidney injury, wound infection (superficial and deep), rate of intraoperative need for vasopressor, incidence of unplanned intensive care unit admission, rate of need for rapid response team call, intensive care unit length of stay, hospital length of stay, and in-hospital mortality. Main Outcomes and Measures The primary outcome was a composite of postoperative pulmonary complications within the first 7 postoperative days, including pneumonia, bronchospasm, atelectasis, pulmonary congestion, respiratory failure, pleural effusion, pneumothorax, or unplanned requirement for postoperative invasive or noninvasive ventilation. All patients received positive end-expiratory pressure (PEEP) at 5 cm H 2O. Interventions Patients were randomized to receive a tidal volume of 6 mL/kg predicted body weight (n = 614 low tidal volume group) or a tidal volume of 10 mL/kg predicted body weight (n = 592 conventional tidal volume group). The last date of follow-up was February 17, 2019. Objective To determine whether low-tidal-volume ventilation compared with conventional ventilation during major surgery decreases postoperative pulmonary complications.ĭesign, Setting, and Participants Single-center, assessor-blinded, randomized clinical trial of 1236 patients older than 40 years undergoing major noncardiothoracic, nonintracranial surgery under general anesthesia lasting more than 2 hours in a tertiary hospital in Melbourne, Australia, from February 2015 to February 2019. Importance In patients who undergo mechanical ventilation during surgery, the ideal tidal volume is unclear. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.Results of the Sensitivity Analysis Allocating 22 Additional Patients in the Conventional Arm With Different Incidences of the Primary Outcomes Risk Ratio for Postoperative Respiratory Complications in Post Hoc SubgroupsĮFigure 5. Results of the Sensitivity Analyses for the Primary OutcomeĮFigure 4. Kaplan-Meier Estimates for Patients in the Low Tidal Volume and Conventional Tidal Volume GroupsĮFigure 3. Trend Over Time for Arterial Blood GasesĮFigure 2. Primary and Secondary Outcomes Only in Patients Undergoing Laparoscopic SurgeryĮFigure 1. Additional Sensitivity Analyses for the Primary OutcomeĮTable 10. Adjusted P Values for the Secondary OutcomesĮTable 9. Protocol Violations and Reason for ViolationsĮTable 8. Detailed Description of Surgical ProceduresĮTable 7. ![]() Missing Values for Study VariablesĮTable 4. Definitions of the Secondary OutcomesĮTable 3. Definition of the Primary OutcomeĮTable 2.
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