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Critical Care
Published in: Critical Care 2/2009

Open Access 01-04-2009 | Research

Impact of intraoperative lung-protective interventions in patients undergoing lung cancer surgery

Authors: Marc Licker, John Diaper, Yann Villiger, Anastase Spiliopoulos, Virginie Licker, John Robert, Jean-Marie Tschopp

Published in: Critical Care | Issue 2/2009

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Abstract

Introduction

In lung cancer surgery, large tidal volume and elevated inspiratory pressure are known risk factors of acute lung (ALI). Mechanical ventilation with low tidal volume has been shown to attenuate lung injuries in critically ill patients. In the current study, we assessed the impact of a protective lung ventilation (PLV) protocol in patients undergoing lung cancer resection.

Methods

We performed a secondary analysis of an observational cohort. Demographic, surgical, clinical and outcome data were prospectively collected over a 10-year period. The PLV protocol consisted of small tidal volume, limiting maximal pressure ventilation and adding end-expiratory positive pressure along with recruitment maneuvers. Multivariate analysis with logistic regression was performed and data were compared before and after implementation of the PLV protocol: from 1998 to 2003 (historical group, n = 533) and from 2003 to 2008 (protocol group, n = 558).

Results

Baseline patient characteristics were similar in the two cohorts, except for a higher cardiovascular risk profile in the intervention group. During one-lung ventilation, protocol-managed patients had lower tidal volume (5.3 ± 1.1 vs. 7.1 ± 1.2 ml/kg in historical controls, P = 0.013) and higher dynamic compliance (45 ± 8 vs. 32 ± 7 ml/cmH2O, P = 0.011). After implementing PLV, there was a decreased incidence of acute lung injury (from 3.7% to 0.9%, P < 0.01) and atelectasis (from 8.8 to 5.0, P = 0.018), fewer admissions to the intensive care unit (from 9.4% vs. 2.5%, P < 0.001) and shorter hospital stay (from 14.5 ± 3.3 vs. 11.8 ± 4.1, P < 0.01). When adjusted for baseline characteristics, implementation of the open-lung protocol was associated with a reduced risk of acute lung injury (adjusted odds ratio of 0.34 with 95% confidence interval of 0.23 to 0.75; P = 0.002).

Conclusions

Implementing an intraoperative PLV protocol in patients undergoing lung cancer resection was associated with improved postoperative respiratory outcomes as evidence by significantly reduced incidences of acute lung injury and atelectasis along with reduced utilization of intensive care unit resources.
Appendix
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Metadata
Title
Impact of intraoperative lung-protective interventions in patients undergoing lung cancer surgery
Authors
Marc Licker
John Diaper
Yann Villiger
Anastase Spiliopoulos
Virginie Licker
John Robert
Jean-Marie Tschopp
Publication date
01-04-2009
Publisher
BioMed Central
Published in
Critical Care / Issue 2/2009
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc7762

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