Lung protective ventilation strategy to reduce postoperative pulmonary complications (PPCs) in patients undergoing robot-assisted laparoscopic radical cystectomy for bladder cancer: A randomized double blinded clinical trial.

Abstract

STUDY OBJECTIVE\nTo evaluate the effects of ventilation with low tidal volume and positive end-expiratory pressure (PEEP) on postoperative pulmonary complications in patients undergoing robot-assisted laparoscopic radical cystectomy (RARC) for bladder cancer.\n\n\nDESIGN\nA prospective randomized double-blinded study.\n\n\nSETTING\nA single center trial in a comprehensive tertiary hospital from January 2017 to January 2019.\n\n\nPATIENTS\nA total of 258 patients undergoing RARC for bladder cancer.\n\n\nINTERVENTIONS\nPatients were randomly assigned to receive either lung-protective ventilation (LPV group) [tidal volume 6\xa0ml/\xa0kg predicated body weight (PBW)\xa0+\xa0PEEP 7 cmH2O] or nonprotective ventilation (control group) (tidal volume 9\xa0ml/\xa0kg PBW without PEEP) during anesthesia.\n\n\nMEASUREMENTS\nThe primary outcome was the occurrence of postoperative pulmonary complications (PPCs) during the first 90\xa0days after surgery. The secondary outcomes were extubation time, oxygenation index (OI) after extubation and at postoperative day 1 in blood gas.\n\n\nMAIN RESULTS\nThe incidence of PPCs at postoperative day1, 2 and 3 were lower in LPV group [26.8% vs. 47.2%, odds ratio (OR) 0.41, 95% confidence interval (CI), 0.24-0.69, P\xa0=\xa00.0007, 21.3% vs. 43.3%, OR 0.36, 95% CI, 0.20-0.61, P\xa0=\xa00.0002, 14.2% vs. 27.5%, OR0.43, 95%CI, 0.23-0.82, P\xa0=\xa00.0087, respectively], while no differences were observed at day 7 and 28 (3.9% vs. 9.4%, P\xa0=\xa00.0788, 0% vs. 1.6%, P\xa0=\xa00.4980, respectively). No PPCs were observed at postoperative day 90 in both groups. Furthermore, immediately after extubating and at postoperative day 1, OI was significantly higher in LPV group compared with control group [390(337-467) vs. 343(303-420), P\xa0=\xa00.0005, 406.7(73.0) vs. 425.5(74.7), P\xa0=\xa00.0440, respectively]. Patients in LPV group had a significant shorter extubation time after operation compared with control group [38(33-54) vs. 35(25-46), P\xa0=\xa00.0012].\n\n\nCONCLUSION\nLPV combining low tidal volume and PEEP during anesthesia for RARC may decrease the incidence of postoperative pulmonary complications.