BACKGROUND
Children are more susceptible to postoperative pulmonary complications (PPCs) due to their smaller functional residual capacity and higher closing volume; however, lung-protective ventilation (LPV) in children requiring one-lung ventilation (OLV) has been relatively underexplored.
OBJECTIVES
To evaluate the effects of LPV and driving pressure-guided ventilation on PPCs in children with OLV.
DESIGN
Randomised, controlled, double-blind study.
SETTING
Single-site tertiary hospital, 6 May 2022 to 31 August 2023.
PATIENTS
213 children aged < 6 years, planned for lung resection secondary to congenital cystic adenomatoid malformation.
INTERVENTIONS
Children were randomly assigned to LPV (n = 142) or control (n = 71) groups. Children in LPV group were randomly assigned to either driving pressure group (n = 70) receiving individualised positive end-expiratory pressure (PEEP) to deliver the lowest driving pressure or to conventional protective ventilation group (n = 72) with fixed PEEP of 5 cmH2O.
MAIN OUTCOME MEASURES
The primary outcome was the incidence of PPCs within 7 days after surgery. Secondary outcomes were pulmonary mechanics, oxygenation and mechanical power.
RESULTS
The incidence of PPCs did not differ between the LPV (24/142, 16.9%) and the control groups (15/71, 21.1%) (P = 0.45). The driving pressure was lower in the driving pressure group than in the 5 cmH2O PEEP group (15 vs. 17 cmH2O; P
= 0.001). Lung compliance and oxygenation were higher while the dynamic component of mechanical power was lower in the driving pressure group than in the 5 cmH2O PEEP group. The incidence of PPCs did not differ between the driving pressure (11/70, 15.7%) and the 5 cmH2O PEEP groups (13/72, 18.1%) (P
= 0.71).
CONCLUSIONS
LPV did not decrease the occurrence of PPCs compared to non-protective ventilation. Although lung compliance and oxygenation were higher in the driving pressure group than in the 5 cmH2O PEEP group, these benefits did not translate into significant reductions in PPCs. However, the study is limited by a small sample size, which may affect the interpretation of the results. Future research with larger sample sizes is necessary to confirm these findings.
TRIAL REGISTRATION
ChiCTR2200059270.
