A trial of intraoperative low-tidal-volume ventilation in abdominal surgery
Abstract
BACKGROUND: Lung-protective ventilation with the use of low tidal volumes and positive end-expiratory pressure is considered best practice in the care of many critically ill patients. However, its role in anesthetized patients undergoing major surgery is not known. METHODS: In this multicenter, double-blind, parallel-group trial, we randomly assigned 400 adults at intermediate to high risk of pulmonary complications after major abdominal surgery to either nonprotective mechanical ventilation or a strategy of lung-protective ventilation. The primary outcome was a composite of major pulmonary and extrapulmonary complications occurring within the first 7 days after surgery. RESULTS: The two intervention groups had similar characteristics at baseline. In the intention-to-treat analysis, the primary outcome occurred in 21 of 200 patients (10.5%) assigned to lung-protective ventilation, as compared with 55 of 200 (27.5%) assigned to nonprotective ventilation (relative risk, 0.40; 95% confidence interval [CI], 0.24 to 0.68; P=0.001). Over the 7-day postoperative period, 10 patients (5.0%) assigned to lung-protective ventilation required noninvasive ventilation or intubation for acute respiratory failure, as compared with 34 (17.0%) assigned to nonprotective ventilation (relative risk, 0.29; 95% CI, 0.14 to 0.61; P=0.001). The length of the hospital stay was shorter among patients receiving lung-protective ventilation than among those receiving nonprotective ventilation (mean difference, -2.45 days; 95% CI, -4.17 to -0.72; P=0.006). CONCLUSIONS: As compared with a practice of nonprotective mechanical ventilation, the use of a lung-protective ventilation strategy in intermediate-risk and high-risk patients undergoing major abdominal surgery was associated with improved clinical outcomes and reduced health care utilization. (IMPROVE ClinicalTrials.gov number, NCT01282996.).
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In the most convincing study so far to test the preventive value of lung-protective ventilation in patients without ARDS, intraoperative use of larger tidal volumes increased the rate of postoperative pneumonia by a factor of five (from 1.5% to 8.0%).
“the intraoperative use of larger tidal volumes (which induce alveolar injury and leak,60 figure 3) increased the rate of postoperative pneumonia by a factor of five (from 1·5% to 8·0%).”
From The microbiome and critical illness (2016) · cites this paper as [116]
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- Authors
- Futier, E., Constantin, J.-M., Paugam-Burtz, C., Pascal, J., Eurin, M., Neuschwander, A., Marret, E., Beaussier, M., Gutton, C., Lefrant, J.-Y., Allaouchiche, B., Verzilli, D., Leone, M., De Jong, A., Bazin, J.-E., Pereira, B., & Jaber, S.
- Affiliations
- Université de Clermont I (FR)
- Hôpital Beaujon (FR)
- Hôpital Tenon (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- Centre Hospitalier Universitaire de Nîmes (FR)
- Hôpital Edouard Herriot (FR)
- Inserm (FR)
- Centre Hospitalier Universitaire de Clermont-Ferrand (FR)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2013-08
- Volume
- 369
- Issue
- 5
- Pages
- 428-437
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2162002744
- Cited by
- 1,434
- References
- 39
- Citations by year
- 2026: 70 · 2025: 83 · 2024: 75 · 2023: 88 · 2022: 123 · 2021: 112 · 2020: 101 · 2019: 122 · 2018: 116 · 2017: 123 · 2016: 126 · 2015: 133 · 2014: 137 · 2013: 16 · 2012: 6
- FWCI
- 111.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Keywords
- lung-protective ventilation, low tidal volume ventilation, positive end-expiratory pressure, abdominal surgery, postoperative pulmonary complications, postoperative respiratory failure, length of hospital stay, mechanical ventilation
- MeSH terms
- Abdomen, Double-Blind Method, Female, Humans, Male, Middle Aged, Positive-Pressure Respiration, Postoperative Complications, Respiratory Insufficiency, Digestive System Surgical Procedures, Tidal Volume, Intention to Treat Analysis, Operative Time
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