Effects of individualized positive end-expiratory pressure on intraoperative oxygenation in thoracic surgical patients: study protocol for a prospective randomized controlled trial

Abstract

Background Intraoperative hypoxemia and postoperative pulmonary complications (PPCs) often occur in patients with one-lung ventilation (OLV), due to both pulmonary shunt and atelectasis. It has been demonstrated that individualized positive end-expiratory pressure (iPEEP) can effectively improve intraoperative oxygenation, increase lung compliance, and reduce driving pressure, thereby decreasing the risk of developing PPCs. However, its effect during OLV is still unknown. Therefore, we aim to investigate whether iPEEP ventilation during OLV is superior to 5 cmH2O PEEP in terms of intraoperative oxygenation and the occurrence of PPCs. Methods This study is a prospective, randomized controlled, single-blind, single-center trial. A total of 112 patients undergoing thoracoscopic pneumonectomy surgery and OLV will be enrolled in the study. They will be randomized into two groups: the static lung compliance guided iPEEP titration group (Cst-iPEEP Group) and the constant 5 cmH2O PEEP group (PEEP 5 Group). The primary outcome will be the oxygenation index at 30 min after OLV and titration. Secondary outcomes are oxygenation index at other operative time points, PPCs, postoperative adverse events, ventilator parameters, vital signs, pH value, inflammatory factors, and economic indicators. Discussion This trial explores the effect of iPEEP on intraoperative oxygenation during OLV and PPCs. It provides some clinical references for optimizing the lung protective ventilation strategy of OLV, improving patient prognosis, and accelerating postoperative rehabilitation. Trial registration www.Chictr.org.cnChiCTR2300073411. Registered on 10 July 2023.

Effect of flow-optimized pressure control ventilation-volume guaranteed (PCV-VG) on postoperative pulmonary complications: a consort study

“…The improved lung compliance at T1, T2, and T4 implies fewer PPCs. Furthermore, the PaO 2 /FiO 2 did not improve significantly in the experimental group but was significantly higher at T3 while the total complication rate was significantly reduced, which is consistent with previous reports [ 5 , 13 , 33 ]. The optimizing ventilation strategies during OLV were closely associated with fewer PPCs and better perioperative oxygenation [ 33 ].…”

“…PPCs occur in approximately 22–43% of patients undergoing OLV [ 1 – 3 ]. During OLV, patients often have intraoperative hypoxemia and PPCs because of pulmonary shunting and atelectasis [ 4 , 5 ]. PPCs occur in up to 59% of thoracic surgery patients [ 4 ].…”

Intraprocedural computed tomography-guided navigation with ventilatory strategy for atelectasis (ICNVA): a modified electromagnetic navigation bronchoscopy

“…The stepwise method using slow-low pressure can achieve lung recruitment while reducing impact on the circulatory system ( 13 , 14 ). LNVP strategy used sustained inflation, higher PEEP, and peak pressure threshold, but this setting violated the protective lung ventilation strategy and may lead to ventilator-related lung injury ( 5 , 6 , 15 - 17 ). In our early cases, we followed the LNVP strategy and found that patients were prone to intraoperative bleeding and hypotension and decreased oxygenation index.…”