Individualised ventilation strategies reduce postoperative pulmonary complications in thoracic surgery patients

An international study led by Clínic-IDIBAPS shows that the administration of individualised pulmonary ventilation strategies for each patient, adjusting respiratory support to individual needs during the intraoperative and immediate postoperative periods, significantly reduces the risk of postoperative pulmonary complications.

Following major surgery under general anaesthesia, pulmonary complications are the most frequent type of complication, occurring in up to 30-40% of patients. One of the most important causes is damage to lung tissue caused by mechanical ventilation. It is important to note that mechanical ventilation is necessary for all patients undergoing general anaesthesia. In the short term, pulmonary complications slow down patients' recovery, prolonging their stay in hospital and increasing the consumption of health care resources.

An international studypublished in the journal The Lancet Respiratory Medicine, led by Clínic-IDIBAPS with the participation of dozens of hospitals around the world, demonstrates that the use of personalised lung ventilation strategies for each individual patient reduces pulmonary complications after thoracic surgery.

"This study represents yet another advance in improving the respiratory management of surgical patients based on personalisation of the strategy according to the needs of the patient and the surgery," says Carlos Ferrando, head of the Anaesthesia and Resuscitation Service at Hospital Clínic Barcelona and a member of the IDIBAPS research group on Applied research in infectious respiratory diseases and critically ill patients and the CIBER research group on respiratory diseases.

The study, financed by the Instituto Superior Carlos III, included 1,380 thoracic surgery patients, who were divided into two groups. Half received conventional perioperative ventilation, the other half an individualised ventilation strategy.

For several years, the research team has been attempting to improve the respiratory management of these patients with the aim of reducing postoperative pulmonary complications. Ferrando thanked "the inestimable collaboration provided by dozens of colleagues in hospitals who have contributed to this major project, one that was especially complex as it was conducted to a large extent during the pandemic."

Reference article: Ferrando C, Carramiñana A, Piñeiro P, Mirabella L, Spadaro S, Librero J, et al. Individualised, perioperative open-lung ventilation strategy during one-lung ventilation (iPROVE-OLV): a multicenter, randomized, controlled clinical trial. Lancet Respir Med 2023 Dec 5:s2213-26600(23)00346-6