• Dharshi Karalapillai, Laurence Weinberg, NetoAry SerpaASAustralian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia., Philip J Peyton, Louise Ellard, Raymond Hu, Brett Pearce, Chong O Tan, David Story, Mark O'Donnell, Patrick Hamilton, Chad Oughton, Jonathan Galtieri, Anthony Wilson, Grace Liskaser, Ajay Balasubramaniam, Glenn Eastwood, Rinaldo Bellomo, and Daryl A Jones.
• Department of Anesthesia, Austin Hospital, Studley Rd, Heidelberg, Melbourne, Victoria, 3084, Australia. dharshi.karalapillai@austin.org.au.
• BMC Anesthesiol. 2023 Mar 7; 23 (1): 7171.

BackgroundWe recently reported the results for a large randomized controlled trial of low tidal volume ventilation (LTVV) versus conventional tidal volume (CTVV) during major surgery when positive end expiratory pressure (PEEP) was equal between groups. We found no difference in postoperative pulmonary complications (PPCs) in patients who received LTVV. However, in the subgroup of patients undergoing laparoscopic surgery, LTVV was associated with a numerically lower rate of PPCs after surgery. We aimed to further assess the relationship between LTVV versus CTVV during laparoscopic surgery.MethodsWe conducted a post-hoc analysis of this pre-specified subgroup. All patients received volume-controlled ventilation with an applied PEEP of 5 cmH2O and either LTVV (6 mL/kg predicted body weight [PBW]) or CTVV (10 mL/kg PBW). The primary outcome was the incidence of a composite of PPCs within seven days.ResultsThree hundred twenty-eight patients (27.2%) underwent laparoscopic surgeries, with 158 (48.2%) randomised to LTVV. Fifty two of 157 patients (33.1%) assigned to LTVV and 72 of 169 (42.6%) assigned to conventional tidal volume developed PPCs within 7 days (unadjusted absolute difference, - 9.48 [95% CI, - 19.86 to 1.05]; p = 0.076). After adjusting for pre-specified confounders, the LTVV group had a lower incidence of the primary outcome than patients receiving CTVV (adjusted absolute difference, - 10.36 [95% CI, - 20.52 to - 0.20]; p = 0.046).ConclusionIn this post-hoc analysis of a large, randomised trial of LTVV we found that during laparoscopic surgeries, LTVV was associated with a significantly reduced PPCs compared to CTVV when PEEP was applied equally between both groups.Trial RegistrationAustralian and New Zealand Clinical Trials Registry no: 12614000790640.© 2023. The Author(s).

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