Article description

Summary:

• The study investigates the impact of low tidal volume (TV) ventilation with positive end-expiratory pressure (PEEP) and alveolar recruitment maneuvers (ARM) on reducing postoperative acute respiratory distress syndrome (ARDS) and pulmonary complications (PPCs).
• Conducted as a multicenter, randomized, single-blind, controlled trial across 16 hospitals in Italy.
• 880 adult patients undergoing elective major lung resection were randomized into two groups: lower tidal volume (LTV) with PEEP and ARMs versus higher tidal volume (HTV) without PEEP and ARMs.
• Primary outcome: Incidence of in-hospital ARDS was low in both groups (0.7% in LTV vs. 0.2% in HTV), with no statistically significant difference.
• Secondary outcomes: The incidence of PPCs was similar in both groups (28.5% in LTV vs. 30.8% in HTV), including pneumonia, atelectasis, and hypoxemia.
• Mortality rates, ICU admissions, and hospital length of stay were comparable between the groups.
• The study was stopped early due to futility, as no significant advantage was found for either ventilation strategy.

Conclusions:

• Both ventilation strategies resulted in a low incidence of ARDS, suggesting that strict adherence to a particular ventilation protocol may not be necessary.
• Further research is needed to refine optimal ventilation approaches, particularly in the context of individualized settings.

Tweet text: A new multicenter RCT in the Journal of Cardiothoracic and Vascular Anesthesia finds no significant difference in ARDS rates between lower and higher tidal volume OLV strategies. Protective one-lung ventilation is evolving—what’s your take?