• Federico Piccioni, Nicola Langiano, Elena Bignami, Marcello Guarnieri, Paolo Proto, Rocco D'Andrea, Carlo A Mazzoli, Ilaria Riccardi, Alessandro Bacuzzi, Luca Guzzetti, Irene Rossi, Sabino Scolletta, Daniela Comi, Alberto Benigni, Federico Pierconti, Cecilia Coccia, Matteo Biscari, Alice Murzilli, Marzia Umari, Caterina Peratoner, Eugenio Serra, Francesco Baldinelli, Rosanna Accardo, Fernanda Diana, Alessandro Fasciolo, Riccardo Amodio, Lorenzo Ball, Massimiliano Greco, Paolo Pelosi, Della RoccaGiorgioGDepartment of Medical Area, University of Udine, Udine, Italy., and One-Lung Ventilation Investigators Group (Supplementary Appendix S1).
• Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy. Electronic address: dr.federico.piccioni@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2023 Dec 1; 37 (12): 256125712561-2571.

ObjectivesThe effect of one-lung ventilation (OLV) strategy based on low tidal volume (TV), application of positive end-expiratory pressure (PEEP), and alveolar recruitment maneuvers (ARM) to reduce postoperative acute respiratory distress syndrome (ARDS) and pulmonary complications (PPCs) compared with higher TV without PEEP and ARM strategy in adult patients undergoing lobectomy or pneumonectomy has not been well established.DesignMulticenter, randomized, single-blind, controlled trial.SettingSixteen Italian hospitals.ParticipantsA total of 880 patients undergoing elective major lung resection.InterventionsPatients were randomized to receive lower tidal volume (LTV group: 4 mL/kg predicted body weight, PEEP of 5 cmH2O, and ARMs) or higher tidal volume (HTL group: 6 mL/kg predicted body weight, no PEEP, and no ARMs). After OLV, until extubation, both groups were ventilated using a tidal volume of 8 mL/kg and a PEEP value of 5 cmH2O. The primary outcome was the incidence of in-hospital ARDS. Secondary outcomes were the in-hospital rate of PPCs, major cardiovascular events, unplanned intensive care unit (ICU) admission, in-hospital mortality, ICU length of stay, and in-hospital length of stay.Measurements And Main ResultsARDS occurred in 3 of 438 patients (0.7%, 95% CI 0.1-2.0) and in 1 of 442 patients (0.2%, 95% CI 0-1.4) in the LTV and HTV group, respectively (Risk ratio: 3.03 95% CI 0.32-29, p = 0.372). Pulmonary complications occurred in 125 of 438 patients (28.5%, 95% CI 24.5-32.9) and in 136 of 442 patients (30.8%, 95% CI 26.6-35.2) in the LTV and HTV group, respectively (risk ratio: 0.93, 95% CI 0.76-1.14, p = 0.507). The incidence of major complications, in-hospital mortality, and unplanned ICU admission, ICU and in-hospital length of stay were comparable in both groups.ConclusionsIn conclusion, among adult patients undergoing elective lung resection, an OLV with lower tidal volume, PEEP 5 cmH2O, and ARMs and a higher tidal volume strategy resulted in low ARDS incidence and comparable postoperative complications, in-hospital length of stay, and mortality.Copyright © 2023 Elsevier Inc. All rights reserved.

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