TY - JOUR
T1 - Low tidal volume ventilation for patients undergoing laparoscopic surgery
T2 - a secondary analysis of a randomised clinical trial
AU - Karalapillai, Dharshi
AU - Weinberg, Laurence
AU - Neto, Ary Serpa
AU - Peyton, Philip J.
AU - Ellard, Louise
AU - Hu, Raymond
AU - Pearce, Brett
AU - Tan, Chong O.
AU - Story, David
AU - O’Donnell, Mark
AU - Hamilton, Patrick
AU - Oughton, Chad
AU - Galtieri, Jonathan
AU - Wilson, Anthony
AU - Liskaser, Grace
AU - Balasubramaniam, Ajay
AU - Eastwood, Glenn
AU - Bellomo, Rinaldo
AU - Jones, Daryl A.
N1 - Funding Information:
We also acknowledge research nurses Sarah Baulch, BN, Gayle Claxton, BN, Sofia Sidiropoulos, BN, and Saskia Harris, BN, in the Department of Anaesthesia, Austin Hospital, Melbourne. This study was undertaken in accordance with the Declaration of Helsinki for research involving human participants.
Funding Information:
The original trial was investigator-initiated research funded by Australian and New Zealand College of Anaesthetists grant ANZAC16/008. Dr. Peyton reported receipt of personal fees from Maquet Critical Care outside of the submitted work. Dr. Wilson reported receipt of personal fees from Fisher Paykel outside of the submitted work. Dr. Serpa Neto reported receiving personal fees from Dräger outside of the submitted work. No other disclosures were reported.
Publisher Copyright:
© 2023, The Author(s).
PY - 2023/12
Y1 - 2023/12
N2 - Background: We recently reported the results for a large randomized controlled trial of low tidal volume ventilation (LTVV) versus conventional tidal volume (CTVV) during major surgery when positive end expiratory pressure (PEEP) was equal between groups. We found no difference in postoperative pulmonary complications (PPCs) in patients who received LTVV. However, in the subgroup of patients undergoing laparoscopic surgery, LTVV was associated with a numerically lower rate of PPCs after surgery. We aimed to further assess the relationship between LTVV versus CTVV during laparoscopic surgery. Methods: We conducted a post-hoc analysis of this pre-specified subgroup. All patients received volume-controlled ventilation with an applied PEEP of 5 cmH2O and either LTVV (6 mL/kg predicted body weight [PBW]) or CTVV (10 mL/kg PBW). The primary outcome was the incidence of a composite of PPCs within seven days. Results: Three hundred twenty-eight patients (27.2%) underwent laparoscopic surgeries, with 158 (48.2%) randomised to LTVV. Fifty two of 157 patients (33.1%) assigned to LTVV and 72 of 169 (42.6%) assigned to conventional tidal volume developed PPCs within 7 days (unadjusted absolute difference, − 9.48 [95% CI, − 19.86 to 1.05]; p = 0.076). After adjusting for pre-specified confounders, the LTVV group had a lower incidence of the primary outcome than patients receiving CTVV (adjusted absolute difference, − 10.36 [95% CI, − 20.52 to − 0.20]; p = 0.046). Conclusion: In this post-hoc analysis of a large, randomised trial of LTVV we found that during laparoscopic surgeries, LTVV was associated with a significantly reduced PPCs compared to CTVV when PEEP was applied equally between both groups. Trial registration: Australian and New Zealand Clinical Trials Registry no: 12614000790640.
AB - Background: We recently reported the results for a large randomized controlled trial of low tidal volume ventilation (LTVV) versus conventional tidal volume (CTVV) during major surgery when positive end expiratory pressure (PEEP) was equal between groups. We found no difference in postoperative pulmonary complications (PPCs) in patients who received LTVV. However, in the subgroup of patients undergoing laparoscopic surgery, LTVV was associated with a numerically lower rate of PPCs after surgery. We aimed to further assess the relationship between LTVV versus CTVV during laparoscopic surgery. Methods: We conducted a post-hoc analysis of this pre-specified subgroup. All patients received volume-controlled ventilation with an applied PEEP of 5 cmH2O and either LTVV (6 mL/kg predicted body weight [PBW]) or CTVV (10 mL/kg PBW). The primary outcome was the incidence of a composite of PPCs within seven days. Results: Three hundred twenty-eight patients (27.2%) underwent laparoscopic surgeries, with 158 (48.2%) randomised to LTVV. Fifty two of 157 patients (33.1%) assigned to LTVV and 72 of 169 (42.6%) assigned to conventional tidal volume developed PPCs within 7 days (unadjusted absolute difference, − 9.48 [95% CI, − 19.86 to 1.05]; p = 0.076). After adjusting for pre-specified confounders, the LTVV group had a lower incidence of the primary outcome than patients receiving CTVV (adjusted absolute difference, − 10.36 [95% CI, − 20.52 to − 0.20]; p = 0.046). Conclusion: In this post-hoc analysis of a large, randomised trial of LTVV we found that during laparoscopic surgeries, LTVV was associated with a significantly reduced PPCs compared to CTVV when PEEP was applied equally between both groups. Trial registration: Australian and New Zealand Clinical Trials Registry no: 12614000790640.
KW - Laparoscopic surgery
KW - Low tidal volume ventilation
KW - Post-operative pulmonary complications
UR - https://www.scopus.com/pages/publications/85149554874
U2 - 10.1186/s12871-023-01998-1
DO - 10.1186/s12871-023-01998-1
M3 - Article
C2 - 36882701
AN - SCOPUS:85149554874
SN - 1471-2253
VL - 23
JO - BMC Anesthesiology
JF - BMC Anesthesiology
IS - 1
M1 - 71
ER -