A trial of intraoperative low-tidal-volume ventilation in abdominal surgery
Emmanuel Futier, Jean-Michel Constantin, Catherine Paugam-Burtz, Julien Pascal, Mathilde Eurin, Arthur Neuschwander, Emmanuel Marret, Marc Beaussier, Christophe Gutton, Jean-Yves Lefrant, Bernard Allaouchiche, Daniel Verzilli, Marc Leone, Audrey De Jong, Jean-Etienne Bazin, Bruno Pereira, Samir Jaber, IMPROVE Study Group, Emmanuel Futier, Samir Jaber, Jean-Michel Constantin, Catherine Paugam-Burtz, Emmanuel Marret, Marc Beaussier, Jean-Yves Lefrant, Bernard Allaouchiche, Emmanuel Futier, Jean-Michel Constantin, Emmanuel Futier, Samir Jaber, Jean-Michel Constantin, Marc Leone, Dominique Morand, Sandrine Saugues, Julien Pascal, Fabrice Kwiatkowski, Elie Azoulaz, Karim Asehnoune, Lise Laclautre Perrier, Bruno Pereira, Emmanuel Futier, Samir Jaber, Jean-Michel Constantin, E Futier, J M Constantin, J E Bazin, A Petit, A Gérard, O Cherbis, S Jaber, D Verzilli, A De Jong, M El Kamel, C Paugam-Burtz, M Eurin, A Neuschwander, E Marret, M L Brulé, J de Montblanc, J F Perrier, O Szymkiewicz, M Beaussier, C Gutton, B Allaouchiche, C Le Goff, A Challan-Belval, J Ripart, J Y Lefrant, Emmanuel Futier, Jean-Michel Constantin, Catherine Paugam-Burtz, Julien Pascal, Mathilde Eurin, Arthur Neuschwander, Emmanuel Marret, Marc Beaussier, Christophe Gutton, Jean-Yves Lefrant, Bernard Allaouchiche, Daniel Verzilli, Marc Leone, Audrey De Jong, Jean-Etienne Bazin, Bruno Pereira, Samir Jaber, IMPROVE Study Group, Emmanuel Futier, Samir Jaber, Jean-Michel Constantin, Catherine Paugam-Burtz, Emmanuel Marret, Marc Beaussier, Jean-Yves Lefrant, Bernard Allaouchiche, Emmanuel Futier, Jean-Michel Constantin, Emmanuel Futier, Samir Jaber, Jean-Michel Constantin, Marc Leone, Dominique Morand, Sandrine Saugues, Julien Pascal, Fabrice Kwiatkowski, Elie Azoulaz, Karim Asehnoune, Lise Laclautre Perrier, Bruno Pereira, Emmanuel Futier, Samir Jaber, Jean-Michel Constantin, E Futier, J M Constantin, J E Bazin, A Petit, A Gérard, O Cherbis, S Jaber, D Verzilli, A De Jong, M El Kamel, C Paugam-Burtz, M Eurin, A Neuschwander, E Marret, M L Brulé, J de Montblanc, J F Perrier, O Szymkiewicz, M Beaussier, C Gutton, B Allaouchiche, C Le Goff, A Challan-Belval, J Ripart, J Y Lefrant
Abstract
Background: Lung-protective ventilation with the use of low tidal volumes and positive end-expiratory pressure is considered best practice in the care of many critically ill patients. However, its role in anesthetized patients undergoing major surgery is not known.
Methods: In this multicenter, double-blind, parallel-group trial, we randomly assigned 400 adults at intermediate to high risk of pulmonary complications after major abdominal surgery to either nonprotective mechanical ventilation or a strategy of lung-protective ventilation. The primary outcome was a composite of major pulmonary and extrapulmonary complications occurring within the first 7 days after surgery.
Results: The two intervention groups had similar characteristics at baseline. In the intention-to-treat analysis, the primary outcome occurred in 21 of 200 patients (10.5%) assigned to lung-protective ventilation, as compared with 55 of 200 (27.5%) assigned to nonprotective ventilation (relative risk, 0.40; 95% confidence interval [CI], 0.24 to 0.68; P=0.001). Over the 7-day postoperative period, 10 patients (5.0%) assigned to lung-protective ventilation required noninvasive ventilation or intubation for acute respiratory failure, as compared with 34 (17.0%) assigned to nonprotective ventilation (relative risk, 0.29; 95% CI, 0.14 to 0.61; P=0.001). The length of the hospital stay was shorter among patients receiving lung-protective ventilation than among those receiving nonprotective ventilation (mean difference, -2.45 days; 95% CI, -4.17 to -0.72; P=0.006).
Conclusions: As compared with a practice of nonprotective mechanical ventilation, the use of a lung-protective ventilation strategy in intermediate-risk and high-risk patients undergoing major abdominal surgery was associated with improved clinical outcomes and reduced health care utilization. (IMPROVE ClinicalTrials.gov number, NCT01282996.).
Source: PubMed