An Optimal Protective Ventilation Strategy to Prevent Immediate Postoperative Pulmonary Complications in Lung Resection Surgery: A Prospective, Single-Center, Three-Arm Randomized Controlled Trial = 폐 절제술을 시행받는 환자에서 수술 후 급성 폐 합병증 예방을 위한 최적의 폐 보호 환기법에 관한 무작위 비교 임상 연구

국문 초록 (Abstract)

폐 보호 환기 전략은 수술 후 인공호흡기로 인한 급성 폐 손상을 줄일 수 있지만, 일측 폐 환기를 위한 최적의 전략은 아직 명확하지 않다. 본 연구는 폐 절제술을 받는 환자에서 수술 후 즉각적인 폐 합병증 발생률을 줄이기 위해 세 가지 보호 환기 전략을 비교하고, 동맥혈 산소 분압/흡입 산소 농도 비율을 평가하였다.

다국어 초록 (Multilingual Abstract)

Background: Protective ventilation reduces ventilator-induced acute lung injury postoperatively; however, the optimal strategy for one-lung ventilation (OLV) remains unclear. This study compared three protective ventilation strategies with a postoperative partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio to reduce the incidence of immediate postoperative pulmonary complications (PPCs) in patients undergoing lung resection surgery.
Material and Methods: Eighty-seven patients with ASA physical status I–III requiring OLV for lung resection surgery were randomized into three groups according to the applied ventilation strategies: low tidal volume (VT) of 4 mL/kg of predicted body weight (PBW) (LV group), medium VT of 6 mL/kg of PBW (MV group), and high VT of 8 mL/kg of PBW (HV group). All patients received 5 cmH2O of positive end-expiratory pressure (PEEP). The primary outcome was the mean difference of PaO2/FiO2 ratio after surgery. The radiologic findings of acute lung injuries were also evaluated. The incidence of immediate PPCs was determined by PaO2/FiO2 ratio of <300 mmHg and/or newly developed radiological findings within 72 h after surgery.
Results: The MV group showed the highest PaO2/FiO2 ratio at 6 h postoperatively (P = 0.010). There were no significant among-group differences in radiological findings in 3 postoperative days. The MV group showed the lowest incidence of immediate PPCs among the three groups (P = 0.007).
Conclusions: During OLV in lung resection surgery, protective ventilation at a VT of 6 mL/kg with PEEP of 5 cmH2O may achieve a higher postoperative PaO2/FiO2 ratio, reducing the incidence of immediate PPCs.

목차 (Table of Contents)

• Introduction 1
• Methods 3
• Results 10
• Discussion 27
• Conclusions 33
• References 34
• Abstract in Korean 42