Ventilatory Mechanics, Oxygenation and Postoperative pulmonary complications according to surgical approach in patients with Individualised Ventilatory Approach. A secondary analysis of the iPROVE-OLV trial.

BACKGROUND: It is uncertain whether ventilatory mechanics and oxygenation during one-lung ventilation and postoperative pulmonary complications (PPCs) differ between surgical approaches (open lung resection, thoracotomy) vs. video-assisted thoracoscopy surgery (VATS) in patients under the application of an individualised perioperative open-lung approach (OLA) ventilation strategy. METHODS: Secondary analysis of a randomized, international, multicenter controlled trial enrolling 1.380 patients (iPROVE-OLV). We analyzed the individualized OLA (iOLA) group and compared both approaches (Thoracotomy vs. VATS). iOLA included protective mechanical ventilation, recruitment maneuvers with individualized positive end-expiratory pressure (PEEP), and individualized postoperative respiratory support with high-flow oxygen therapy. The main aim was to compare driving pressure, PEEP, compliance, and oxygenation during OLV (T2) based on the surgical approach. Secondary outcomes included PPCs. RESULTS: A total of 645 patients were analyzed (458 VATS, 187 thoracotomy). Intraoperative PEEP during OLV was similar between VATS and thoracotomy group (5.07 ± 1.73 vs. 5.19 ± 1.67 cmH2O, p = 0.461), as well as plateau pressure (18.59±4.53 vs. 18.87 ± 5.04 cmH2O, p = 0.539), driving pressure (13.50±4.68 vs. 13.67 ± 5.16, p = 0.725), and dynamic compliance (34.70±14.19 vs. 34.37 ± 12.29 ml/cmH2O, p = 0.802). The PaO2/FiO2 ratio was also similar in both groups during T2 (185.47 ± 91.75 vs. 197.64 ± 102.61 mmHg, p = 0.160). Risk of severe PPCs within the first 7 and 30 postoperative days was comparable between VATS and thoracotomy [24 (5.24%) vs. 15 (8.02%), RR: 1.53 (95%CI: 0.82-2.85), p = 0.20], [30 (6.55%) vs. 17 (9.09%), RR: 1.38 (95%CI: 0.78-2.45), p = 0.315]. CONCLUSIONS: Among patients undergoing lung resection procedures in whom an iOLA approach was performed, ventilatory mechanics and oxygenation were comparable between VATS and thoracotomy, with no significant differences in severe PPCs during the first 7 and 30 postoperative days.