Intra-operative protective mechanical ventilation in lung transplantation: a randomised, controlled trial.
Verbeek GL, Myles PS, et al.Anaesthesia 2017; 72(8): 993-1004.
Aims
To evaluate the feasibility, safety and efficacy of an open-lung protective ventilation strategy in lung transplant recipients.
Interventions
Participants were stratified according to lung disease and randomised to receive either volume-controlled ventilation with 5cmH2O, positive end-expiratory pressure, low tidal volumes (control group), versus regular step-wise positive end-expiratory pressure-based alveolar recruitment manoeuvres, pressure-controlled ventilation set at 16cmH2O with 10cmH2O positive end-expiratory pressure (alveolar recruitment group).
Participants
33 patients undergoing bilateral sequential lung transplantation aged ≥ 18 years.
Outcomes
The primary outcome measured was PaO2/FIO2 ratio 24h after the first lung reperfusion. Secondary outcomes included PaO2/FIO2 ratio during one-lung and two-lung ventilation, primary graft dysfunction grade, intra-operative fluid requirements, duration of extracorporeal membrane oxygenation (ECMO) support in ICU, duration and mode of mechanical ventilation in ICU, length of stay in hospital and ICU, and pentraxin-3 and sRAGE levels.
Follow-up
24 hours
CET Conclusions
In this study the primary outcome was not different between the two groups. There was an improvement immediately post-operatively, but this was not sustained, and only evident after adjusting for ï¬nal PaO2/FIO2 ratio before procurement and ï¬rst lung ischaemic time. Significantly the control group had longer ischaemic times than the study group. The authors acknowledged that the sample size calculated was possibly a bit ambitious (only 15 in each arm).
Data analysis
Modified intention-to-treat analysis
Trial registration
Not described