Individualized peep after recruitment maneuver during one lung ventilation and pulmonary complications for thoracic surgery: a prospective observational cohort

Abstract

Introduction Thoracic surgery by thoracotomy is associated with postoperative pulmonary complications. The goal of the our study was to observe whether the use of Individualized PEEP after lung recruitment during one lung ventilation was associated with a decrease in the rate of postoperative pulmonary complications. Methods This is an observational prospective cohort study. Data from consecutive patients older than 18 years old undergoing lung resection were prospectively collected from January 1st to April 30th 2019. The primary outcome was pulmonary complications after surgery, as defined by guidelines. Non-parametric test (Wilcoxon rank-sum and Fischer´s exact test) were used to compare the continuous and dichotomic variables between the groups using individualized PEEP and the non-individualized group. Individualized-PEEP was determined by best compliance. In non-individualized PEEP group, a PEEP of 5 mmHg was used. Stata 13.1 was used for data analysis. Results Data from 34 consecutive patients were prospectively collected. In 6 of them individualized-PEEP was used. In the individualized-PEEP group the median PEEP was 7 (median [IQR], 7 [6-8]). Pulmonary complications were observed in 6 patients (5 pleural effusion and 1 pneumothorax). No significant differences in pulmonary complications after lung resection were observed (%, 17.8% vs 16.6%, p 0.71). No significant differences in oxygenation at ICU admission were observed (PaO2/FiO2 ratio median [IQR], 380 [326-446] vs 408 [354-420], p 0.75). The results of this study should be seen with caution due to a relative small sample size and possible lack of power to detect differences between groups. Discussion The use of an intraoperative individualized PEEP after lung recriutment strategy during one-lung ventilation was not associated with a decrease in pulmonary complications after thoracic surgery. Its use was associated with a trend towards an increase in oxygenation at ICU admission. However, this difference was not statistically significant. Data from studies with larger sample size and power are warranted.