Effect of ventilation mode on pulmonary complications after thoracoscopic lung resection: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIN Liang ^1,2 , YU Hong ¹ , MAO Wenjie ^1,3 , SUN Qirong ¹ , TIAN Wei ¹ ,  YU Hai ¹

1. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Anesthesiology, Leshan People's Hospital, Leshan, 614000, Sichuan, P. R. China;
3. Department of Anesthesiology, Jianyang People's Hospital, Chengdu, 641400, P. R. China;

Corresponding author：

YU Hai, Email: yuhaishan117@yahoo.com

Keywords：

Ventilation mode; thoracoscopic lung resection; postoperative pulmonary complications; one-lung ventilation

DOI：

10.7507/1007-4848.202106042

Video：

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Objective To evaluate the association between pressure-controlled ventilation-volume guaranteed (PCV-VG) mode and volume-controlled ventilation (VCV) mode on postoperative pulmonary complications (PPCs) in patients undergoing thoracoscopic lung resection. Methods A retrospective cohort analysis of 329 patients undergoing elective thoracoscopic lung resection in West China Hospital of Sichuan University between September 2020 and March 2021 was conducted, including 213 females and 116 males, aged 53.6±11.3 years. American Society of Anesthesiologists (ASA) grade wasⅠ-Ⅲ. The patients who received lung-protective ventilation strategy during anesthesia were divided into a PCV-VG group (n=165) and a VCV group (n=164) according to intraoperative ventilation mode. Primary outcome was the incidence of PPCs during hospitalization. Results A total of 73 (22.2%) patients developed PPCs during hospitalization. The PPCs incidence of PCV-VG and VCV was 21.8% and 22.6%, respectively (RR=0.985, 95%CI 0.569-1.611, P=0.871). Multivariate logistic regression analysis showed that there was no statistical difference in the incidence of PPCs between PCV-VG and VCV mode during hospitalization (OR=0.846, 95%CI 0.487-1.470, P=0.553). Conclusion Among patients undergoing thoracoscopic lung resection, intraoperative ventilation mode (PCV-VG or VCV) is not associated with the risk of PPCs during hospitalization.

Citation： JIN Liang, YU Hong, MAO Wenjie, SUN Qirong, TIAN Wei, YU Hai. Effect of ventilation mode on pulmonary complications after thoracoscopic lung resection: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(2): 211-218. doi: 10.7507/1007-4848.202106042 Copy

1.	de la Gala F, Piñeiro P, Reyes A, et al. Postoperative pulmonary complications, pulmonary and systemic inflammatory responses after lung resection surgery with prolonged one-lung ventilation. Randomized controlled trial comparing intravenous and inhalational anaesthesia. Br J Anaesth, 2017, 119(4): 655-663.
2.	Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology, 2010, 113(6): 1338-1350.
3.	Lohser J, Slinger P. Lung injury after one-lung ventilation: A review of the pathophysiologic mechanisms affecting the ventilated and the collapsed lung. Anesth Analg, 2015, 121(2): 302-318.
4.	Young CC, Harris EM, Vacchiano C, et al. Lung-protective ventilation for the surgical patient: International expert panel-based consensus recommendations. Br J Anaesth, 2019, 123(6): 898-913.
5.	Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: Recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg, 2019, 55(1): 91-115.
6.	Kim MS, Soh S, Kim SY, et al. Comparisons of pressure-controlled ventilation with volume guarantee and volume-controlled 1∶1 equal ratio ventilation on oxygenation and respiratory mechanics during robot-assisted laparoscopic radical prostatectomy: A randomized-controlled trial. Int J Med Sci, 2018, 15(13): 1522-1529.
7.	Assad OM, El Sayed AA, Khalil MA. Comparison of volume-controlled ventilation and pressure-controlled ventilation volume guaranteed during laparoscopic surgery in Trendelenburg position. J Clin Anesth, 2016, 34: 55-61.
8.	Tan J, Song Z, Bian Q, et al. Effects of volume-controlled ventilation vs. pressure-controlled ventilation on respiratory function and inflammatory factors in patients undergoing video-assisted thoracoscopic radical resection of pulmonary carcinoma. J Thorac Dis, 2018, 10(3): 1483-1489.
9.	Park M, Ahn HJ, Kim JA, et al. Driving pressure during thoracic surgery: A randomized clinical trial. Anesthesiology, 2019, 130(3): 385-393.
10.	Neto AS, Hemmes SN, Barbas CS, et al. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: A meta-analysis of individual patient data. Lancet Respir Med, 2016, 4(4): 272-280.
11.	Bagchi A, Rudolph MI, Ng PY, et al. The association of postoperative pulmonary complications in 109, 360 patients with pressure-controlled or volume-controlled ventilation. Anaesthesia, 2017, 72(11): 1334-1343.
12.	Rudolph MI, Eikermann M. Postoperative pulmonary complications and thoracic patients—A reply. Anaesthesia, 2018, 73(3): 394-395.
13.	Song SY, Jung JY, Cho MS, et al. Volume-controlled versus pressure-controlled ventilation-volume guaranteed mode during one-lung ventilation. Korean J Anesthesiol, 2014, 67(4): 258-263.
14.	Li J, Cai B, Yu D, et al. Pressure-controlled ventilation-volume guaranteed mode combined with an open-lung approach improves lung mechanics, oxygenation parameters, and the inflammatory response during one-lung ventilation: A randomized controlled trial. Biomed Res Int, 2020, 2020: 1403053.
15.	Mazo V, Sabaté S, Canet J, et al. Prospective external validation of a predictive score for postoperative pulmonary complications. Anesthesiology, 2014, 121(2): 219-231.
16.	Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: A statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol, 2015, 32(2): 88-105.
17.	von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet, 2007, 370(9596): 1453-1457.
18.	Serpa Neto A, Hemmes SN, Barbas CS, et al. Incidence of mortality and morbidity related to postoperative lung injury in patients who have undergone abdominal or thoracic surgery: A systematic review and meta-analysis. Lancet Respir Med, 2014, 2(12): 1007-1015.
19.	Lugg ST, Agostini PJ, Tikka T, et al. Long-term impact of developing a postoperative pulmonary complication after lung surgery. Thorax, 2016, 71(2): 171-176.
20.	Colquhoun DA, Leis AM, Shanks AM, et al. A lower tidal volume regimen during one-lung ventilation for lung resection surgery is not associated with reduced postoperative pulmonary complications. Anesthesiology, 2021, 134(4): 562-576.
21.	Karalapillai D, Weinberg L, Peyton P, et al. Effect of intraoperative low tidal volume vs conventional tidal volume on postoperative pulmonary complications in patients undergoing major surgery: A randomized clinical trial. JAMA, 2020, 324(9): 848-858.
22.	Sarkaria IS, Gorrepati ML, Mehendale S, et al. Lobectomy in octogenarians: Real world outcomes for robotic-assisted, video-assisted thoracoscopic, and open approaches. J Thorac Dis, 2019, 11(6): 2420-2430.
23.	Yu Y, Qian X, Liu C, et al. Effect of high-flow nasal cannula versus conventional oxygen therapy for patients with thoracoscopic lobectomy after extubation. Can Respir J, 2017, 2017: 7894631.
24.	Bailey KL, Merchant N, Seo YJ, et al. Short-term readmissions after open, thoracoscopic, and robotic lobectomy for lung cancer based on the nationwide readmissions database. World J Surg, 2019, 43(5): 1377-1384.
25.	Im Y, Park HY, Shin S, et al. Prevalence of and risk factors for pulmonary complications after curative resection in otherwise healthy elderly patients with early stage lung cancer. Respir Res, 2019, 20(1): 136.
26.	Ellenberger C, Garofano N, Reynaud T, et al. Patient and procedural features predicting early and mid-term outcome after radical surgery for non-small cell lung cancer. J Thorac Dis, 2018, 10(11): 6020-6029.
27.	Slinger P, Campos JH. Anesthesia for thoracic surgery. In: Gropper MA, ed. Miller's Anesthesia. 9th ed. Philadelphia, PA: Elsevier, 2020: 1649.
28.	Li XF, Hu JR, Wu Y, et al. Comparative effect of propofol and volatile anesthetics on postoperative pulmonary complications after lung resection surgery: A randomized clinical trial. Anesth Analg, 2021, 133(4): 949-957.
29.	Schick V, Dusse F, Eckardt R, et al. Comparison of volume-guaranteed or -targeted, pressure-controlled ventilation with volume-controlled ventilation during elective surgery: A systematic review and meta-analysis. J Clin Med, 2021, 10(6): 1276.
30.	Kim YS, Won YJ, Lee DK, et al. Lung ultrasound score-based perioperative assessment of pressure-controlled ventilation-volume guaranteed or volume-controlled ventilation in geriatrics: A prospective randomized controlled trial. Clin Interv Aging, 2019, 14: 1319-1329.
31.	Mathis MR, Duggal NM, Likosky DS, et al. Intraoperative mechanical ventilation and postoperative pulmonary complications after cardiac surgery. Anesthesiology, 2019, 131(5): 1046-1062.
32.	沈启英, 陶洪霞, 宗志军, 等. 长时间单肺通气患者非通气侧肺损伤时巨噬细胞状态的变化. 中华麻醉学杂志, 2017, 37(1): 39-42.
33.	杨懿, 刘伦旭. 单孔胸腔镜与传统多孔胸腔镜手术治疗肺癌有效性及安全性的系统评价与Meta分析. 中国胸心血管外科临床杂志, 2018, 25(3): 222-232.
34.	王天佑, 胸外科围手术期肺保护中国专家共识(2019版)专家组, 中国医学基金会胸外科专业委员会. 胸外科围手术期肺保护中国专家共识(2019版). 中国胸心血管外科临床杂志, 2019, 26(9): 835-842.

1. de la Gala F, Piñeiro P, Reyes A, et al. Postoperative pulmonary complications, pulmonary and systemic inflammatory responses after lung resection surgery with prolonged one-lung ventilation. Randomized controlled trial comparing intravenous and inhalational anaesthesia. Br J Anaesth, 2017, 119(4): 655-663.
2. Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology, 2010, 113(6): 1338-1350.
3. Lohser J, Slinger P. Lung injury after one-lung ventilation: A review of the pathophysiologic mechanisms affecting the ventilated and the collapsed lung. Anesth Analg, 2015, 121(2): 302-318.
4. Young CC, Harris EM, Vacchiano C, et al. Lung-protective ventilation for the surgical patient: International expert panel-based consensus recommendations. Br J Anaesth, 2019, 123(6): 898-913.
5. Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: Recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg, 2019, 55(1): 91-115.
6. Kim MS, Soh S, Kim SY, et al. Comparisons of pressure-controlled ventilation with volume guarantee and volume-controlled 1∶1 equal ratio ventilation on oxygenation and respiratory mechanics during robot-assisted laparoscopic radical prostatectomy: A randomized-controlled trial. Int J Med Sci, 2018, 15(13): 1522-1529.
7. Assad OM, El Sayed AA, Khalil MA. Comparison of volume-controlled ventilation and pressure-controlled ventilation volume guaranteed during laparoscopic surgery in Trendelenburg position. J Clin Anesth, 2016, 34: 55-61.
8. Tan J, Song Z, Bian Q, et al. Effects of volume-controlled ventilation vs. pressure-controlled ventilation on respiratory function and inflammatory factors in patients undergoing video-assisted thoracoscopic radical resection of pulmonary carcinoma. J Thorac Dis, 2018, 10(3): 1483-1489.
9. Park M, Ahn HJ, Kim JA, et al. Driving pressure during thoracic surgery: A randomized clinical trial. Anesthesiology, 2019, 130(3): 385-393.
10. Neto AS, Hemmes SN, Barbas CS, et al. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: A meta-analysis of individual patient data. Lancet Respir Med, 2016, 4(4): 272-280.
11. Bagchi A, Rudolph MI, Ng PY, et al. The association of postoperative pulmonary complications in 109, 360 patients with pressure-controlled or volume-controlled ventilation. Anaesthesia, 2017, 72(11): 1334-1343.
12. Rudolph MI, Eikermann M. Postoperative pulmonary complications and thoracic patients—A reply. Anaesthesia, 2018, 73(3): 394-395.
13. Song SY, Jung JY, Cho MS, et al. Volume-controlled versus pressure-controlled ventilation-volume guaranteed mode during one-lung ventilation. Korean J Anesthesiol, 2014, 67(4): 258-263.
14. Li J, Cai B, Yu D, et al. Pressure-controlled ventilation-volume guaranteed mode combined with an open-lung approach improves lung mechanics, oxygenation parameters, and the inflammatory response during one-lung ventilation: A randomized controlled trial. Biomed Res Int, 2020, 2020: 1403053.
15. Mazo V, Sabaté S, Canet J, et al. Prospective external validation of a predictive score for postoperative pulmonary complications. Anesthesiology, 2014, 121(2): 219-231.
16. Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: A statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol, 2015, 32(2): 88-105.
17. von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet, 2007, 370(9596): 1453-1457.
18. Serpa Neto A, Hemmes SN, Barbas CS, et al. Incidence of mortality and morbidity related to postoperative lung injury in patients who have undergone abdominal or thoracic surgery: A systematic review and meta-analysis. Lancet Respir Med, 2014, 2(12): 1007-1015.
19. Lugg ST, Agostini PJ, Tikka T, et al. Long-term impact of developing a postoperative pulmonary complication after lung surgery. Thorax, 2016, 71(2): 171-176.
20. Colquhoun DA, Leis AM, Shanks AM, et al. A lower tidal volume regimen during one-lung ventilation for lung resection surgery is not associated with reduced postoperative pulmonary complications. Anesthesiology, 2021, 134(4): 562-576.
21. Karalapillai D, Weinberg L, Peyton P, et al. Effect of intraoperative low tidal volume vs conventional tidal volume on postoperative pulmonary complications in patients undergoing major surgery: A randomized clinical trial. JAMA, 2020, 324(9): 848-858.
22. Sarkaria IS, Gorrepati ML, Mehendale S, et al. Lobectomy in octogenarians: Real world outcomes for robotic-assisted, video-assisted thoracoscopic, and open approaches. J Thorac Dis, 2019, 11(6): 2420-2430.
23. Yu Y, Qian X, Liu C, et al. Effect of high-flow nasal cannula versus conventional oxygen therapy for patients with thoracoscopic lobectomy after extubation. Can Respir J, 2017, 2017: 7894631.
24. Bailey KL, Merchant N, Seo YJ, et al. Short-term readmissions after open, thoracoscopic, and robotic lobectomy for lung cancer based on the nationwide readmissions database. World J Surg, 2019, 43(5): 1377-1384.
25. Im Y, Park HY, Shin S, et al. Prevalence of and risk factors for pulmonary complications after curative resection in otherwise healthy elderly patients with early stage lung cancer. Respir Res, 2019, 20(1): 136.
26. Ellenberger C, Garofano N, Reynaud T, et al. Patient and procedural features predicting early and mid-term outcome after radical surgery for non-small cell lung cancer. J Thorac Dis, 2018, 10(11): 6020-6029.
27. Slinger P, Campos JH. Anesthesia for thoracic surgery. In: Gropper MA, ed. Miller's Anesthesia. 9th ed. Philadelphia, PA: Elsevier, 2020: 1649.
28. Li XF, Hu JR, Wu Y, et al. Comparative effect of propofol and volatile anesthetics on postoperative pulmonary complications after lung resection surgery: A randomized clinical trial. Anesth Analg, 2021, 133(4): 949-957.
29. Schick V, Dusse F, Eckardt R, et al. Comparison of volume-guaranteed or -targeted, pressure-controlled ventilation with volume-controlled ventilation during elective surgery: A systematic review and meta-analysis. J Clin Med, 2021, 10(6): 1276.
30. Kim YS, Won YJ, Lee DK, et al. Lung ultrasound score-based perioperative assessment of pressure-controlled ventilation-volume guaranteed or volume-controlled ventilation in geriatrics: A prospective randomized controlled trial. Clin Interv Aging, 2019, 14: 1319-1329.
31. Mathis MR, Duggal NM, Likosky DS, et al. Intraoperative mechanical ventilation and postoperative pulmonary complications after cardiac surgery. Anesthesiology, 2019, 131(5): 1046-1062.
32. 沈启英, 陶洪霞, 宗志军, 等. 长时间单肺通气患者非通气侧肺损伤时巨噬细胞状态的变化. 中华麻醉学杂志, 2017, 37(1): 39-42.
33. 杨懿, 刘伦旭. 单孔胸腔镜与传统多孔胸腔镜手术治疗肺癌有效性及安全性的系统评价与Meta分析. 中国胸心血管外科临床杂志, 2018, 25(3): 222-232.
34. 王天佑, 胸外科围手术期肺保护中国专家共识(2019版)专家组, 中国医学基金会胸外科专业委员会. 胸外科围手术期肺保护中国专家共识(2019版). 中国胸心血管外科临床杂志, 2019, 26(9): 835-842.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of ventilation mode on pulmonary complications after thoracoscopic lung resection: A retrospective cohort study

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