Association of Different Tidal Volumes and Postoperative Pulmonary Complications

Association of Various Introperative Tidal Volumes and Postoperative Pulmonary Complications After Video-assisted Thoracic Surgery

The incidence of lung cancer in China is increasing year by year. Currently, the treatment primarily based on video-assisted thoracoscopic surgery (VATS) is still considered the optimal approach for early-stage non-small cell lung cancer. The widespread application of traditional one-lung ventilation (OLV) technology not only achieves effective lung isolation, but also facilitates exposure of the surgical field during thoracoscopic surgery, making it more convenient for surgeons to operate. However, the occurrence of hypoxemia during one-lung ventilation may pose a risk to patient safety.

One-lung ventilation can lead to increased intrapulmonary shunt, ventilation/perfusion (V/Q) mismatch, and ischemic-hypoxic lung injury. Hypoxemia is the major problem during one-lung ventilation. Postoperative pulmonary complications (PPCs) are among the major complications following thoracic and general anesthesia surgeries, including atelectasis, pneumonia, and respiratory failure, which significantly prolong hospital stay and increase mortality.

Low tidal volume lung-protective ventilation strategies have been widely implemented. Additionally, permissive hypercapnia, reducing peak airway pressure to minimize barotrauma, and decreasing FiO₂ all help reduce pulmonary complications.Recently, researchers have focused on optimizing ventilation strategies during OLV, such as using PEEP or low VT ventilation alone or in combination, or exploring different combinations of tidal volume and respiratory frequency under consistent minute ventilation (VE), aiming to balance lung protection and oxygenation, reduce complications, and improve patient outcomes.

However, to date, there is still no gold standard tidal volume ventilation strategy for reducing pulmonary complications in patients undergoing lung resection.

Study Overview

• Status: Not yet recruiting
• Conditions: Pulmonary Complications; Hypoxemia During Surgery; Lung Cancer (Non-Small Cell); One Lung Ventillation (OLV); Thoracic Surgery, Video Assisted

• Study Type: Observational
• Enrollment (Estimated): 650

Contacts and Locations

• Study Contact: Name: Hui Ye, M.D.; Phone Number: 8615267048716; Email: yehui@zju.edu.cn

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients undergoing video-assisted lung surgery

Description

Inclusion Criteria:

• Age > 50 years.
• ASA physical status I-II.
• The cardiopulmonary and other vital organ functions are basically normal, and the patient is able to tolerate surgery.
• Ariscat score > 26.
• Informed consent has been obtained.

Exclusion Criteria:

• Patients who refuse to participate in the clinical trial, or have cognitive impairment or impaired ability to understand and express themselves.
• ASA physical status ≥ III.
• Patients with congestive heart failure, severe aortic stenosis, or extensive pleural adhesions.
• Patients with severe psychiatric disorders or allergy to anesthesia-related medications.
• Patients with severe organ dysfunction such as the liver or kidney dysfunction.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative Pulmonary Complications (PPCs)	Postoperative Pulmonary Complications (PPCs): Incidence of any PPC within 7 days postoperatively	1-7 days after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of hypoxemia	Incidence of hypoxemia: Occurring before the end of surgery	during surgery
Length of Hospital Stay	Length of Hospital Stay	through study completion, an average of 1 year

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intraoperative Oxygenation Index	Intraoperative Oxygenation Index	during surgery
Intraoperative Lung Compliance	Intraoperative Lung Compliance	during surgery
Intraoperative Driving Pressure	Intraoperative Driving Pressure	during surgery
Intraoperative Dead Space to Tidal Volume Ratio (Vd/Vt)	Intraoperative Dead Space to Tidal Volume Ratio (Vd/Vt)	during surgery
Surgeon Satisfaction	The degree of surgeon satisfaction regarding the performance, effectiveness, and experience of a procedure. A 10-point scale is used, 0 indicates complete dissatisfaction and 10 indicates complete satisfaction.	At the end of surgery
In-hospital mortality	In-hospital mortality	through study completion, an average of 1 year
28-day mortality	28-day mortality	28 day postoperatively
90-day mortality	90-day mortality	90 day postoperatively

Collaborators and Investigators

• Sponsor: First Affiliated Hospital of Zhejiang University

Study record dates

Study Major Dates

• Study Start (Estimated): January 20, 2026
• Primary Completion (Estimated): January 24, 2029
• Study Completion (Estimated): February 1, 2029

Study Registration Dates

• First Submitted: January 5, 2026
• First Submitted That Met QC Criteria: January 19, 2026
• First Posted (Actual): January 28, 2026

Study Record Updates

• Last Update Posted (Actual): January 28, 2026
• Last Update Submitted That Met QC Criteria: January 19, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: one lung ventilation; pulmonary complications; hypoxemia; video-assisted thoracic surgery
• Additional Relevant MeSH Terms: Neoplasms by Site; Neoplasms; Respiratory Tract Diseases; Lung Diseases; Respiratory Tract Neoplasms; Thoracic Neoplasms; Lung Neoplasms; Signs and Symptoms, Respiratory; Carcinoma, Bronchogenic; Bronchial Neoplasms; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Hypoxia; Carcinoma, Non-Small-Cell Lung
• Other Study ID Numbers: VolumePPC

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No