Individualized mechanical ventilation strategies to avoid pulmonary complications after surgery

Individualized mechanical ventilation strategies to avoid pulmonary complications after surgery

⇒ The results of the study have been published in the scientific journal Lancet Respiratory Medicine. Our research group in Anesthesia, within the line of research of organic lung damage, runs a clinical trial in which 21 hospitals from all over Spain have participated. The study has been funded by the Carlos III Health Institute within the Health Research Funds program and by the European Society of Anesthesiology-ESA. This study is not only the one that has included the largest number of patients today in the world, but it is also the first study in which the ventilatory strategy is continually individualized to the pulmonary condition of each patient during and after of the abdominal surgical intervention. In the iPROVE trial, a total of 967 patients were analyzed, the characteristics of the patients to be included was 18 years of age or older, scheduled for abdominal surgeries over 2 hours after surgery, who had intermediate or high risk of developing pulmonary complications. after the intervention and had a body mass index no higher than 35. In addition to being informed and having given their consent to be part of the investigation. The objective of the study was to compare different pulmonary protection ventilatory strategies, from the most individualized to the most standard. The results on postoperative complications suggest that an individualized ventilatory approach during the intraoperative and immediate postoperative period could be of clinical relevance, since all the included patients had healthy lungs and were treated with protective mechanical ventilation. In the words of Dr. Carlos Ferrando, researcher at INCLIVA and anesthesiologist at the Hospital Clínic of Valencia: “although the primary result is negative, the study has shown that personalized mechanical ventilation strategies reduce intraoperative hypoxemic events (lack of oxygen during the intervention), pulmonary complications and infection of surgical wound, in addition to reducing the time of stay in the Intensive Care Unit “.

Spanish coordination in first level research
The results of the study have been published in the first international journal of the respiratory specialty, it is one of the few independent clinical trials, financed with public resources, which has been promoted by the INCLIVA-University Clinical Hospital of Valencia and in which 21 university hospitals participated.
IPROVE Research Network:
Department of Anesthesiology & Critical Care, Hospital Clínico Universitario, Valencia, Spain (C Ferrando PhD, M Soro PhD, I León PhD, E Gracia MD, J Puig PhD, J Belda PhD); CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain (C Ferrando, F Suarez-Sipmann PhD, J Villar PhD); Department of Anesthesiology & Critical Care, Hospital Universitario Sant Pau, Barcelona, Spain (I India MD, M Giné MD, G Azparren MD, C Unzueta PhD); Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden (F Suarez-Sipmann); Department of Anesthesiology & Critical Care, Hospital Universitario Germans Tries i Pujol, Badalona, Spain (J Canet PhD, A Brunelli MD); Navarrabiomed-Fundación Miguel Servet. Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain (J Librero PhD); INCLIVA Clinical Research Institute, Hospital Clinico Universitario de Valencia, Valencia, Spain (N Pozo PhD); Centro Superior de Investigación en Salud Publica (CSISP-FISABIO), REDISSEC, Valencia, Spain (S Peiró PhD); IISLAFE Clinical Research Institute (A Llombart Pharm) and Department of Anesthesiology & Critical Care (O Díaz-Cambronero MD, N García MD), Hospital Universitario y Politécnico La Fe, Valencia, Spain; Department of Anesthesiology & Critical Care, Hospital Universitario Río Hortega, Valladolid, Spain (C Aldecoa PhD, M García MD); Department of Anesthesiology & Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain (D Pestaña PhD, L Miguel MD); Department of Anesthesiology & Critical Care, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain (F J Redondo PhD, S Sánchez MD); Department of Anesthesiology & Critical Care, Hospital General Universitario Gregorio Marañón, Madrid, Spain (I Garutti PhD, P Piñeiro MD); Department of Anesthesiology & Critical Care, Hospital Clínic i Provincial Universitario, Barcelona, Spain (J Balust MD, R Pujol MD); Department of Anesthesiology & Critical Care, Hospital Fundación de Alcorcón, Alcorcón, Spain (J I García MD, S García-del-Valle MD); Department of Anesthesiology, Hospital de la Marina Baixa de la Vila Joiosa, Alicante, Spain (M Ibáñez MD, J Valdivia MD); Department of Anesthesiology & Critical Care, Hospital General Universitario, Valencia, Spain (M Granell PhD, M J Hernández MD); Department of Anesthesiology, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain (A Rodríguez PhD, O Padrón MD); Department of Anesthesiology & Critical Care, Hospital Universitario Miguel Servet, Zaragoza, Spain (L Gallego PhD, A Colás MD); Department of Anesthesiology & Critical Care, Hospital Universitario Virgen del Rocio, Sevilla, Spain (M de la Matta PhD); Department of Anesthesiology, Hospital Universitario de León, León, Spain (R Gonzalez MD); Department of Anesthesiology & Critical Care, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain (J García PhD); Department of Anesthesiology, Hospital de Manises, Valencia, Spain.
Access:
Ferrando C, Soro M, Unzueta C, Suarez-Sipmann F, Canet J, Librero J, Pozo N, Peiró S, Llombart A, León I, India I, Aldecoa C, Díaz-Cambronero O, Pestaña D, Redondo FJ, Garutti I, Balust J, García JI, Ibáñez M, Granell M, Rodríguez A, Gallego L, de la Matta M, Gonzalez R, Brunelli A, García J, Rovira L, Barrios F, Torres V, Hernández S, Gracia E, Giné M, García M, García N, Miguel L, Sánchez S, Piñeiro P, Pujol R, García-Del-Valle S, Valdivia J, Hernández MJ, Padrón O, Colás A, Puig J, Azparren G, Tusman G, Villar J, Belda J; Individualized PeRioperative Open-lung VEntilation (iPROVE) Network.  Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial. Lancet Respir Med. 2018 Mar;6(3):193-203. doi: 10.1016/S2213-2600(18)30024-9. Epub 2018 Jan 19.]]>

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