• Mohamed R El Tahan, Evangelia Samara, Nandor Marczin, Giovanni Landoni, and Laura Pasin.
• Anesthesiology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Al Khubar, Dammam, Saudi Arabia.
• J. Cardiothorac. Vasc. Anesth. 2023 Oct 1; 37 (10): 198319921983-1992.

ObjectivesTo clarify the influence of lower tidal volume (4-7 mL/kg) compared with higher tidal volume (8-15 mL/kg) during one-lung ventilation (OLV) on gas exchange and postoperative clinical outcome.DesignMeta-analysis of randomized trials.SettingThoracic surgery.ParticipantsPatients receiving OLV.InterventionsLower tidal volume during OLV.Measurements And Main ResultsPrimary outcome was PaO2-to-the oxygen fraction (PaO2/FIO2) ratio at the end of the surgery, after the reinstitution of two-lung ventilation. Secondary endpoints included perioperative changes in PaO2/FIO2 ratio and carbon dioxide (PaCO2) tension, airway pressure, the incidence of postoperative pulmonary complications, arrhythmia, and length of hospital stay. Seventeen randomized controlled trials (1,463 patients) were selected. Overall analysis showed that the use of low tidal volume during OLV was associated with a significantly higher PaO2/FIO2 ratio 15 minutes after the start of OLV and at the end of surgery (mean difference 33.7 mmHg [p = 0.02] and mean difference 18.59 mmHg [p < 0.001], respectively). The low tidal volume also was associated with higher PaCO2 values 15 minutes and 60 minutes after the start of OLV and with lower airway pressure, which was maintained during two-lung ventilation after surgery. Moreover, the application of lower tidal volume was associated with fewer postoperative pulmonary complications (odds ratio 0.50; p < 0.001) and arrhythmias (odds ratio 0.58; p = 0.009), with no difference in length of hospital stay.ConclusionsThe use of lower tidal volume, a component of protective OLV, increases the PaO2/FIO2 ratio, reduces the incidence of postoperative pulmonary complications, and should be considered strongly in daily practice.Copyright © 2023 Elsevier Inc. All rights reserved.

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