Intra-operative protective mechanical ventilation in lung transplantation: a randomised, controlled trial.Verbeek GL, Myles PS, et al.
Anaesthesia 2017; 72(8): 993-1004.
To evaluate the feasibility, safety and efficacy of an open-lung protective ventilation strategy in lung transplant recipients.
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).
33 patients undergoing bilateral sequential lung transplantation aged ≥ 18 years.
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.
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 ﬁnal PaO2/FIO2 ratio before procurement and ﬁrst 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).