Lung protective ventilation during pulmonary resection in children: a prospective, single-centre, randomised controlled trial.

Abstract

Perioperative ventilatory strategies for lung protection in children are underexplored. This study evaluated the effects of lung protective ventilation (LPV) on postoperative clinical outcomes in children requiring one-lung ventilation (OLV) for pulmonary resection. Children age ≤5 yr scheduled for video-assisted thoracoscopic lung lobectomy or segmentectomy were randomly assigned to LPV or control ventilation. For LPV, tidal volume (V_T) was 6 ml kg^-1 during two-lung ventilation (TLV_(VT)), 4 ml kg^-1 during OLV, with 6 cm H₂O PEEP maintained throughout. In the control group, TLV_(VT) was 10 ml kg^-1, 8 ml kg^-1 during OLV, but without PEEP. The primary outcome was the incidence of pulmonary complications within 72 h after operation. Secondary outcomes included intraoperative desaturation, arterial oxygen partial pressure/inspiratory fraction of oxygen (P/F) ratio >40 kPa, and development of consolidation and B-lines (assessed by lung ultrasound at the end of surgery, by an investigator masked to group allocation). Odds ratio (OR) with 95% confidence intervals are reported. Overall, 19/110 (17.3%) children sustained pulmonary complications after surgery. LPV reduced pulmonary complications (5/55; 9.1%), compared with 14/55 (25.5%) children sustaining complications in the control group (OR=0.29 [0.10-0.88]; P=0.02). Masked ultrasound assessment showed less consolidation, and fewer B-lines, after LPV (P<0.001). Intraoperative desaturation was more common in control mode (eight/55; 14.5%), compared with 1/55 (1.8%) after LPV (OR=9.2 [1.1-76]; P=0.015). LPV maintained (P/F) ratio >40 more frequently (53/55; 96.4%) than control-mode (45/55; 81.8%) ventilation (OR=5.9 [1.2-28.3%]; P<0.01). Lung protective ventilation decreased postoperative pulmonary complications compared with conventional ventilation in children requiring one-lung ventilation for pulmonary resection. NCT02680925.