iOLA associated with a reduced risk of severe postoperative pulmonary complications compared to standard lung-protective ventilation

 A study has shown that in  individuals undergoing lung resection with one-lung ventilation, individualised open-lung approach (iOLA) had a lower risk of severe postoperative pulmonary complications compared to conventional lung-protective ventilation. This study’s findings were published in the journal, Lancet Respiratory Medicine.

In this randomised controlled trial, patients aged 18 years and above were randomised into two groups: one receiving iOLA (n=670) and the other receiving standard lung-protective ventilation (n=638). The iOLA treatment involved an alveolar recruitment manoeuvre with an end-inspiratory pressure of 40 cm H₂O, followed by individualised positive end-expiratory pressure (PEEP) adjusted to achieve optimal respiratory system compliance. Additionally, participants in the iOLA group received personalised postoperative respiratory support through high-flow oxygen therapy. On the other hand, participants in the standard lung-protective ventilation group received 4 cm H₂O of PEEP during surgery and conventional oxygen therapy after surgery. The primary outcome measured was the occurrence of severe postoperative pulmonary complications within the first 7 days after surgery.

At the end of the study, patients in the iOLA group had a lower incidence of severe postoperative pulmonary complications within the first 7 days post-surgery compared to those in the standard lung-protective ventilation group [40 patients (6%) vs 97 patients (15%)].

According to the above study, in patients undergoing lung resection with one-lung ventilation, the utilization of iOLA was found to be linked to a decreased likelihood of experiencing severe postoperative pulmonary complications in comparison to the use of conventional lung-protective ventilation.