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.
STUDY OBJECTIVE
To 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.


DESIGN
A prospective randomized double-blinded study.


SETTING
A single center trial in a comprehensive tertiary hospital from January 2017 to January 2019.


PATIENTS
A total of 258 patients undergoing RARC for bladder cancer.


INTERVENTIONS
Patients were randomly assigned to receive either lung-protective ventilation (LPV group) [tidal volume 6 ml/ kg predicated body weight (PBW) + PEEP 7 cmH2O] or nonprotective ventilation (control group) (tidal volume 9 ml/ kg PBW without PEEP) during anesthesia.


MEASUREMENTS
The primary outcome was the occurrence of postoperative pulmonary complications (PPCs) during the first 90 days after surgery. The secondary outcomes were extubation time, oxygenation index (OI) after extubation and at postoperative day 1 in blood gas.


MAIN RESULTS
The 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 = 0.0007, 21.3% vs. 43.3%, OR 0.36, 95% CI, 0.20-0.61, P = 0.0002, 14.2% vs. 27.5%, OR0.43, 95%CI, 0.23-0.82, P = 0.0087, respectively], while no differences were observed at day 7 and 28 (3.9% vs. 9.4%, P = 0.0788, 0% vs. 1.6%, P = 0.4980, 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 = 0.0005, 406.7(73.0) vs. 425.5(74.7), P = 0.0440, 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 = 0.0012].


CONCLUSION
LPV combining low tidal volume and PEEP during anesthesia for RARC may decrease the incidence of postoperative pulmonary complications.
['Huang|Dan|D|', 'Zhou|Shujing|S|', 'Yu|Zhangjie|Z|', 'Chen|Jie|J|', 'Xie|Hong|H|']
D015653:Cystectomy D006801:Humans D010535:Laparoscopy D008168:Lung D011183:Postoperative Complications D011446:Prospective Studies D012371:Robotics D013990:Tidal Volume D001749:Urinary Bladder Neoplasms
Lung protective ventilation Postoperative pulmonary complications Robot-assisted laparoscopic radical cystectomy Low tidal volume Positive end-expiratory pressure