New evidence in one-lung ventilation

Meleiro, Hugo; Correia, I.; Mora, Pedro Charco

doi:10.1016/j.redare.2018.01.009

Cited by 8 publications

(10 citation statements)

References 22 publications

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“…On the other hand, the Italian and Japanese anesthesiologists tend to recommend a low tidal volume (4 to 6 ml/kg PBW) for OLV [1,22]. Nevertheless, opinions from the expert anesthesiologists highlight that protective ventilation in thoracic anesthesia is not simply synonymous of a low tidal volume, but also involves the appropriate application of PEEP, alveolar recruitment and other ventilatory settings during OLV [23,24]. Most recently, a double-blind, [21].…”

Section: Resultsmentioning

confidence: 99%

A nationwide survey of intraoperative management for one-lung ventilation in Taiwan: time to accountable for diversity in protective lung ventilation

Kuo

Liu

Chen

et al. 2020

Preprint

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Background: There is a major paradigm shift for intraoperative mechanical ventilator support by the introduction of lung protective ventilation strategies to reduce postoperative pulmonary complications and improve overall clinical outcomes in non-thoracic surgeries. However, there is currently a lack of standardized practice guideline for lung protection during thoracic surgeries that require one-lung ventilation (OLV). This study aimed to collect the expert opinions of the thoracic anesthesiologists in perioperative care for OLV surgery in Taiwan. Methods: This prospective cross-sectional study was undertaken in 16 tertiary hospitals in Taiwan from January to February 2019. A structured survey form was distributed across the participating hospitals and the thoracic anesthesiologists were invited to complete the form voluntarily. The survey form consisted of three parts, including the basic information of the institutional anesthesia care standards, ventilatory settings for a proposed patient receiving OLV surgery and expert opinions on OLV. Results: A total of 71 thoracic anesthesiologists responded to the survey. Double-lumen tubes are the most commonly used (93.8%) airway devices for OLV. The most commonly recommended ventilator setting during OLV is a tidal volume of 6-7 ml/kg PBW (67.6%) and a PEEP level of 4-6 cmH2O (73.5%). Dual controlled ventilator modes are used by 44.1% of the anesthesiologists. During OLV, high oxygen fraction (FiO2 >0.8) is more commonly supplemented to achieve an oxygen saturation higher than 94%. The consensus of anesthesiologists on the indices for lung protection in thoracic surgery is considerably low. Large majority of the anesthesiologists (91.5%) highly recommend that an international clinical practice guideline on the protective lung ventilation strategy for thoracic anesthesia should be established. Conclusions: This study found that the thoracic anesthesiologists in Taiwan share certain common practices in ventilator support during OLV. However, they are concerned about the lack of fundamental clinical evidences to support the beneficial outcomes of the current lung protective strategies applicable to OLV. Large-scale trials are needed to form an evidence-based clinical practice guideline for thoracic anesthesia.

show abstract

Section: Resultsmentioning

confidence: 99%

A nationwide survey of intraoperative management for one-lung ventilation in Taiwan: time to accountable for diversity in protective lung ventilation

Kuo

Liu

Chen

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…On the other hand, the Italian and Japanese anesthesiologists tend to recommend a low tidal volume (4 to 6 ml/kg PBW) for OLV [1,17]. Nevertheless, opinions from the expert anesthesiologists highlight that protective ventilation in thoracic anesthesia is not simply synonymous of a low tidal volume, but also involves the appropriate application of PEEP, alveolar recruitment and other ventilatory settings during OLV [18,19]. Most recently, a double-blind, randomized controlled trial conducted at the Samsung Medical Center (Seoul, Korea) demonstrated that driving pressure-guided ventilation (median ∆P of 9 cmH 2 O) during OLV significantly reduced the incidence of postoperative pulmonary complications compared with the conventional protective ventilation (tidal volume 6 ml/kg PBW, PEEP 5 cmH 2 O and recruitment) in thoracic surgery [20].…”

Section: Resultsmentioning

confidence: 99%

A nationwide survey of intraoperative management for one-lung ventilation in Taiwan: time to accountable for diversity in protective lung ventilation

Kuo

Liu

Lam

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: There is a major paradigm shift for intraoperative mechanical ventilator support by the introduction of lung protective ventilation strategies to reduce postoperative pulmonary complications and improve overall clinical outcomes in non-thoracic surgeries. However, there is currently a lack of standardized practice guideline for lung protection during thoracic surgeries that require one-lung ventilation (OLV). This study aimed to collect the expert opinions of the thoracic anesthesiologists in perioperative care for OLV surgery in Taiwan.Methods: This prospective cross-sectional study was undertaken in 16 tertiary hospitals in Taiwan from January to February 2019. A structured survey form was distributed across the participating hospitals and the thoracic anesthesiologists were invited to complete the form voluntarily. The survey form consisted of three parts, including the basic information of the institutional anesthesia care standards, ventilatory settings for a proposed patient receiving OLV surgery and expert opinions on OLV.Results: A total of 71 thoracic anesthesiologists responded to the survey. Double-lumen tubes are the most commonly used (93.8%) airway devices for OLV. The most commonly recommended ventilator setting during OLV is a tidal volume of 6-7 ml/kg PBW (67.6%) and a PEEP level of 4-6 cmH2O (73.5%). Dual controlled ventilator modes are used by 44.1% of the anesthesiologists. During OLV, high oxygen fraction (FiO2 >0.8) is more commonly supplemented to achieve an oxygen saturation higher than 94%. The consensus of anesthesiologists on the indices for lung protection in thoracic surgery is considerably low. Large majority of the anesthesiologists (91.5%) highly recommend that an international clinical practice guideline on the protective lung ventilation strategy for thoracic anesthesia should be established.Conclusions: This study found that the thoracic anesthesiologists in Taiwan share certain common practices in ventilator support during OLV. However, they are concerned about the lack of fundamental clinical evidences to support the beneficial outcomes of the current lung protective strategies applicable to OLV. Large-scale trials are needed to form an evidence-based clinical practice guideline for thoracic anesthesia.

show abstract

“…Furthermore, the Italian and Japanese anesthesiologists recommend a lower tidal volume (4-6 ml/kg PBW) for OLV [1,22]. Nevertheless, opinions from the expert anesthesiologists highlight that protective ventilation in thoracic anesthesia is not simply synonymous of a low tidal volume, but also involves the appropriate application of PEEP, alveolar recruitment and other ventilatory settings during OLV [23,24]. Most recently, a double-blind, randomized controlled trial conducted at the Samsung Medical Center (Seoul, Korea) demonstrated that driving pressure-guided ventilation (median ΔP of 9 cmH 2 O) during OLV significantly reduced the incidence of postoperative pulmonary complications compared with the conventional protective ventilation (tidal volume 6 ml/kg PBW, PEEP 5 cmH 2 O and recruitment) in thoracic surgery [25].…”

Section: Discussionmentioning

confidence: 99%

A nationwide survey of intraoperative management for one-lung ventilation in Taiwan: time to accountable for diversity in protective lung ventilation

et al. 2020

View full text Add to dashboard Cite

Background There is a major paradigm shift for intraoperative mechanical ventilator support by the introduction of lung protective ventilation strategies to reduce postoperative pulmonary complications and improve overall clinical outcomes in non-thoracic surgeries. However, there is currently a lack of standardized practice guideline for lung protection during thoracic surgeries that require one-lung ventilation (OLV). This study aimed to collect the expert opinions of the thoracic anesthesiologists in perioperative care for OLV surgery in Taiwan. Methods This prospective cross-sectional study was undertaken in 16 tertiary hospitals in Taiwan from January to February 2019. A structured survey form was distributed across the participating hospitals and the thoracic anesthesiologists were invited to complete the form voluntarily. The survey form consisted of three parts, including the basic information of the institutional anesthesia care standards, ventilatory settings for a proposed patient receiving OLV surgery and expert opinions on OLV. Results A total of 71 thoracic anesthesiologists responded to the survey. Double-lumen tubes are the most commonly used (93.8%) airway devices for OLV. The most commonly recommended ventilator setting during OLV is a tidal volume of 6–7 ml/kg PBW (67.6%) and a PEEP level of 4–6 cmH2O (73.5%). Dual controlled ventilator modes are used by 44.1% of the anesthesiologists. During OLV, high oxygen fraction (FiO2 > 0.8) is more commonly supplemented to achieve an oxygen saturation higher than 94%. The consensus of anesthesiologists on the indices for lung protection in thoracic surgery is considerably low. Large majority of the anesthesiologists (91.5%) highly recommend that an international clinical practice guideline on the protective lung ventilation strategy for thoracic anesthesia should be established. Conclusions This study found that the thoracic anesthesiologists in Taiwan share certain common practices in ventilator support during OLV. However, they are concerned about the lack of fundamental clinical evidences to support the beneficial outcomes of the current lung protective strategies applicable to OLV. Large-scale trials are needed to form an evidence-based clinical practice guideline for thoracic anesthesia.

show abstract

New evidence in one-lung ventilation

Cited by 8 publications

References 22 publications

A nationwide survey of intraoperative management for one-lung ventilation in Taiwan: time to accountable for diversity in protective lung ventilation

A nationwide survey of intraoperative management for one-lung ventilation in Taiwan: time to accountable for diversity in protective lung ventilation

A nationwide survey of intraoperative management for one-lung ventilation in Taiwan: time to accountable for diversity in protective lung ventilation

A nationwide survey of intraoperative management for one-lung ventilation in Taiwan: time to accountable for diversity in protective lung ventilation

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