The world’s most extensive study of patient safety during major lung surgery has provided new insights into optimal ventilation strategies to reduce complications.
Conducted by the Department of Anaesthesiology and Intensive Care Medicine at the Carl Gustav Carus University Hospital in Dresden and the TU Dresden Faculty of Medicine, it is a significant step forward.
Until now, it was unclear how different ventilation strategies during lung surgery affect the risk of complications.
The PROTHOR study now provides physicians with guidance on choosing the most appropriate ventilation approach during such anaesthesia. The results were published in the journal Lancet Respiratory Medicine.
During lung surgery, the lung that is being operated on must be selectively collapsed while the other lung is mechanically ventilated.
One-lung ventilation places greater mechanical strain on the ventilated lung, increasing the risk of postoperative pulmonary complications, including respiratory failure and pneumonia. Which ventilation strategy can reduce these complications during major lung operations remains unclear.
The PROTHOR study investigated whether ventilation with higher positive end-expiratory pressure (PEEP) and recruitment manoeuvres reduces the risk of pulmonary complications compared with lower PEEP without such manoeuvres.
PEEP refers to the pressure that exists in the lungs at the end of exhalation. Recruitment manoeuvres help reopen closed alveoli. However, higher PEEP and recruitment manoeuvres can also negatively affect blood pressure.
Over the period of eight years, 2,200 patients at 74 centres in 28 countries were examined for this purpose.
The results showed that ventilation with increased PEEP and recruitment manoeuvres improved gas exchange in the lungs, whereas lower PEEP was associated with more stable circulatory conditions during anaesthesia.
The incidence of postoperative pulmonary complications did not differ between the groups. The choice of ventilation concept should therefore be made on an individual basis and after careful consideration of the patient's condition during surgery.
Professor Uwe Platzbecker, medical director at the University Hospital said: ‘These new research findings enable improved ventilation during complex lung surgery and contribute to patient safety. The PROTHOR study shows the responsibility we take on in patient care.’
Professor Esther Troost, dean of the Faculty of Medicine at TU Dresden, added: ‘University medicine in Dresden stands for close exchange between research and clinical care. The PROTHOR study impressively proves this and sets standards far beyond Germany.’
Dr Jakob Wittenstein, international coordinator and first author of the study, said: ‘This success was only possible thanks to the close and dedicated collaboration of 248 scientists from four continents. Our sincere thanks go to everyone involved—without their efforts, this study would not have been possible.’
Clinic Director Professor Thea Koch said: ‘Our clinic is particularly committed to transferring findings from clinical research into routine care. This is why we lead and support large international studies such as PROTHOR. Especially in such complex procedures, anaesthesia and differentiated ventilation play a crucial role in the success of the treatment.’
