Tidal volume during 1-lung ventilation: A systematic review and meta-analysis.

Acute Lung Injury / prevention & control Humans Length of Stay Respiration, Artificial Tidal Volume
1-lung ventilation artificial lung compliance respiration thoracic surgery ventilator-induced lung injury

Journal

The Journal of thoracic and cardiovascular surgery
ISSN: 1097-685X
Titre abrégé: J Thorac Cardiovasc Surg
Pays: United States
ID NLM: 0376343

Informations de publication

Date de publication:
Apr 2022
Historique:
received: 22 08 2020
revised: 20 11 2020
accepted: 07 12 2020
pubmed: 2 2 2021
medline: 23 3 2022
entrez: 1 2 2021
Statut: ppublish

Résumé

The selection of tidal volumes for 1-lung ventilation remains unclear, because there exists a trade-off between oxygenation and risk of lung injury. We conducted a systematic review and meta-analysis to determine how oxygenation, compliance, and clinical outcomes are affected by tidal volume during 1-lung ventilation. A systematic search of MEDLINE and EMBASE was performed. A systematic review and random-effects meta-analysis was conducted. Pooled mean difference estimated arterial oxygen tension, compliance, and length of stay; pooled odds ratio was calculated for composite postoperative pulmonary complications. Risk of bias was determined using the Cochrane risk of bias and Newcastle-Ottawa tools. Eighteen studies were identified, comprising 3693 total patients. Low tidal volumes (5.6 [±0.9] mL/kg) were not associated with significant differences in partial pressure of oxygen (-15.64 [-88.53-57.26] mm Hg; P = .67), arterial oxygen tension to fractional intake of oxygen ratio (14.71 [-7.83-37.24]; P = .20), or compliance (2.03 [-5.22-9.27] mL/cmH2O; P = .58) versus conventional tidal volume ventilation (8.1 [±3.1] mL/kg). Low versus conventional tidal volume ventilation had no significant impact on hospital length of stay (-0.42 [-1.60-0.77] days; P = .49). Low tidal volumes are associated with significantly decreased odds of pulmonary complications (pooled odds ratio, 0.40 [0.29-0.57]; P < .0001). Low tidal volumes during 1-lung ventilation do not worsen oxygenation or compliance. A low tidal volume ventilation strategy during 1-lung ventilation was associated with a significant reduction in postoperative pulmonary complications.

Sections du résumé

BACKGROUND BACKGROUND
The selection of tidal volumes for 1-lung ventilation remains unclear, because there exists a trade-off between oxygenation and risk of lung injury. We conducted a systematic review and meta-analysis to determine how oxygenation, compliance, and clinical outcomes are affected by tidal volume during 1-lung ventilation.
METHODS METHODS
A systematic search of MEDLINE and EMBASE was performed. A systematic review and random-effects meta-analysis was conducted. Pooled mean difference estimated arterial oxygen tension, compliance, and length of stay; pooled odds ratio was calculated for composite postoperative pulmonary complications. Risk of bias was determined using the Cochrane risk of bias and Newcastle-Ottawa tools.
RESULTS RESULTS
Eighteen studies were identified, comprising 3693 total patients. Low tidal volumes (5.6 [±0.9] mL/kg) were not associated with significant differences in partial pressure of oxygen (-15.64 [-88.53-57.26] mm Hg; P = .67), arterial oxygen tension to fractional intake of oxygen ratio (14.71 [-7.83-37.24]; P = .20), or compliance (2.03 [-5.22-9.27] mL/cmH2O; P = .58) versus conventional tidal volume ventilation (8.1 [±3.1] mL/kg). Low versus conventional tidal volume ventilation had no significant impact on hospital length of stay (-0.42 [-1.60-0.77] days; P = .49). Low tidal volumes are associated with significantly decreased odds of pulmonary complications (pooled odds ratio, 0.40 [0.29-0.57]; P < .0001).
CONCLUSIONS CONCLUSIONS
Low tidal volumes during 1-lung ventilation do not worsen oxygenation or compliance. A low tidal volume ventilation strategy during 1-lung ventilation was associated with a significant reduction in postoperative pulmonary complications.

Identifiants

DOI: 10.1016/j.jtcvs.2020.12.054 PMID: 33518385
pubmed: 33518385
pii: S0022-5223(20)33408-5
doi: 10.1016/j.jtcvs.2020.12.054
pii:
doi:

Types de publication

Journal Article Meta-Analysis Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

1573-1585.e1

Commentaires et corrections

Type : CommentIn
Type : CommentIn

Informations de copyright

Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Auteurs

John K Peel (JK)

Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.

Duane J Funk (DJ)

Departments of Anesthesia and Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

Peter Slinger (P)

Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.

Sadeesh Srinathan (S)

Section of Thoracic Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.

Biniam Kidane (B)

Section of Thoracic Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Research Institute in Oncology and Hematology, Winnipeg, Manitoba, Canada. Electronic address: b.kidane@mail.utoronto.ca.

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Classifications MeSH

questionsmedicales.fr › Maladies de l'appareil respiratoire › Maladies pulmonaires › Lésion pulmonaire aigüe › Tidal volume during 1-lung ventilation: A...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Tidal volume during 1-lung ventilation: A...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Hospitalisation › Durée du séjour › Tidal volume during 1-lung ventilation: A...
questionsmedicales.fr › Thérapeutique › Thérapie respiratoire › Ventilation artificielle › Tidal volume during 1-lung ventilation: A...
questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiologiques respiratoires › Capacité pulmonaire totale › Capacité vitale › Capacité inspiratoire › Volume courant › Tidal volume during 1-lung ventilation: A...