The Society for Translational Medicine: Clinical practice guidelines for mechanical ventilation management for patients undergoing lobectomy

Shugeng Gao; Zhongheng Zhang; Alessandro Brunelli; Chang Chen; Chun Chen; Gang Chen; Haiquan Chen; Jin Shing Chen; Stephen Cassivi; Ying Chai; John B. Downs; Wentao Fang; Xiangning Fu; Martínez I. Garutti; Jianxing He; Jie He; Jian Hu; Yunchao Huang; Gening Jiang; Hongjing Jiang; Zhongmin Jiang; Danqing Li; Gaofeng Li; Hui Li; Qiang Li; Xiaofei Li; Yin Li; Zhijun Li; Chia Chuan Liu; Deruo Liu; Lunxu Liu; Yongyi Liu; Haitao Ma; Weimin Mao; Yousheng Mao; Juwei Mou; Calvin Sze Hang Ng; René H. Petersen; Guibin Qiao; Gaetano Rocco; Erico Ruffini; Lijie Tan; Qunyou Tan; Tang Tong; Haidong Wang; Qun Wang; Ruwen Wang; Shumin Wang; Deyao Xie; Qi Xue; Tao Xue; Lin Xu; Shidong Xu; Songtao Xu; Tiansheng Yan; Fenglei Yu; Zhentao Yu; Chunfang Zhang; Lanjun Zhang; Tao Zhang; Xun Zhang; Xiaojing Zhao; Xuewei Zhao; Xiuyi Zhi; Qinghua Zhou

doi:10.21037/jtd.2017.08.166

The Society for Translational Medicine: Clinical practice guidelines for mechanical ventilation management for patients undergoing lobectomy

Shugeng Gao, Zhongheng Zhang, Alessandro Brunelli, Chang Chen, Chun Chen, Gang Chen, Haiquan Chen, Jin Shing Chen, Stephen Cassivi, Ying Chai, John B. Downs, Wentao Fang, Xiangning Fu, Martínez I. Garutti, Jianxing He, Jie He, Jian Hu, Yunchao Huang, Gening Jiang, Hongjing JiangZhongmin Jiang, Danqing Li, Gaofeng Li, Hui Li, Qiang Li, Xiaofei Li, Yin Li, Zhijun Li, Chia Chuan Liu, Deruo Liu, Lunxu Liu, Yongyi Liu, Haitao Ma, Weimin Mao, Yousheng Mao, Juwei Mou, Calvin Sze Hang Ng, René H. Petersen, Guibin Qiao, Gaetano Rocco, Erico Ruffini, Lijie Tan, Qunyou Tan, Tang Tong, Haidong Wang, Qun Wang, Ruwen Wang, Shumin Wang, Deyao Xie, Qi Xue, Tao Xue, Lin Xu, Shidong Xu, Songtao Xu, Tiansheng Yan, Fenglei Yu, Zhentao Yu, Chunfang Zhang, Lanjun Zhang, Tao Zhang, Xun Zhang, Xiaojing Zhao, Xuewei Zhao, Xiuyi Zhi, Qinghua Zhou

Cardiovascular Surgery

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

Patients undergoing lobectomy are at significantly increased risk of lung injury. One-lung ventilation is the most commonly used technique to maintain ventilation and oxygenation during the operation. It is a challenge to choose an appropriate mechanical ventilation strategy to minimize the lung injury and other adverse clinical outcomes. In order to understand the available evidence, a systematic review was conducted including the following topics: (I) protective ventilation (PV); (II) mode of mechanical ventilation [e.g., volume controlled (VCV) versus pressure controlled (PCV)]; (III) use of therapeutic hypercapnia; (IV) use of alveolar recruitment (open-lung) strategy; (V) pre-and post-operative application of positive end expiratory pressure (PEEP); (VI) Inspired Oxygen concentration; (VII) Non-intubated thoracoscopic lobectomy; and (VIII) adjuvant pharmacologic options. The recommendations of class II are non-intubated thoracoscopic lobectomy may be an alternative to conventional one-lung ventilation in selected patients. The recommendations of class IIa are: (I) Therapeutic hypercapnia to maintain a partial pressure of carbon dioxide at 50-70 mmHg is reasonable for patients undergoing pulmonary lobectomy with one-lung ventilation; (II) PV with a tidal volume of 6 mL/kg and PEEP of 5 cmH₂O are reasonable methods, based on current evidence; (III) alveolar recruitment [open lung ventilation (OLV)] may be beneficial in patients undergoing lobectomy with one-lung ventilation; (IV) PCV is recommended over VCV for patients undergoing lung resection; (V) pre- and post-operative CPAP can improve short-term oxygenation in patients undergoing lobectomy with one-lung ventilation; (VI) controlled mechanical ventilation with I:E ratio of 1:1 is reasonable in patients undergoing one-lung ventilation; (VII) use of lowest inspired oxygen concentration to maintain satisfactory arterial oxygen saturation is reasonable based on physiologic principles; (VIII) Adjuvant drugs such as nebulized budesonide, intravenous sivelestat and ulinastatin are reasonable and can be used to attenuate inflammatory response.

Original language	English (US)
Pages (from-to)	3246-3254
Number of pages	9
Journal	Journal of Thoracic Disease
Volume	9
Issue number	9
DOIs	https://doi.org/10.21037/jtd.2017.08.166
State	Published - Sep 1 2017

Keywords

Guideline
Lobectomy
Mechanical ventilation
Tidal volume

ASJC Scopus subject areas

Pulmonary and Respiratory Medicine

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10.21037/jtd.2017.08.166

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Gao, S., Zhang, Z., Brunelli, A., Chen, C., Chen, C., Chen, G., Chen, H., Chen, J. S., Cassivi, S., Chai, Y., Downs, J. B., Fang, W., Fu, X., Garutti, M. I., He, J., He, J., Hu, J., Huang, Y., Jiang, G., ... Zhou, Q. (2017). The Society for Translational Medicine: Clinical practice guidelines for mechanical ventilation management for patients undergoing lobectomy. Journal of Thoracic Disease, 9(9), 3246-3254. https://doi.org/10.21037/jtd.2017.08.166

Gao, S, Zhang, Z, Brunelli, A, Chen, C, Chen, C, Chen, G, Chen, H, Chen, JS, Cassivi, S, Chai, Y, Downs, JB, Fang, W, Fu, X, Garutti, MI, He, J, He, J, Hu, J, Huang, Y, Jiang, G, Jiang, H, Jiang, Z, Li, D, Li, G, Li, H, Li, Q, Li, X, Li, Y, Li, Z, Liu, CC, Liu, D, Liu, L, Liu, Y, Ma, H, Mao, W, Mao, Y, Mou, J, Ng, CSH, Petersen, RH, Qiao, G, Rocco, G, Ruffini, E, Tan, L, Tan, Q, Tong, T, Wang, H, Wang, Q, Wang, R, Wang, S, Xie, D, Xue, Q, Xue, T, Xu, L, Xu, S, Xu, S, Yan, T, Yu, F, Yu, Z, Zhang, C, Zhang, L, Zhang, T, Zhang, X, Zhao, X, Zhao, X, Zhi, X & Zhou, Q 2017, 'The Society for Translational Medicine: Clinical practice guidelines for mechanical ventilation management for patients undergoing lobectomy', Journal of Thoracic Disease, vol. 9, no. 9, pp. 3246-3254. https://doi.org/10.21037/jtd.2017.08.166

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title = "The Society for Translational Medicine: Clinical practice guidelines for mechanical ventilation management for patients undergoing lobectomy",

abstract = "Patients undergoing lobectomy are at significantly increased risk of lung injury. One-lung ventilation is the most commonly used technique to maintain ventilation and oxygenation during the operation. It is a challenge to choose an appropriate mechanical ventilation strategy to minimize the lung injury and other adverse clinical outcomes. In order to understand the available evidence, a systematic review was conducted including the following topics: (I) protective ventilation (PV); (II) mode of mechanical ventilation [e.g., volume controlled (VCV) versus pressure controlled (PCV)]; (III) use of therapeutic hypercapnia; (IV) use of alveolar recruitment (open-lung) strategy; (V) pre-and post-operative application of positive end expiratory pressure (PEEP); (VI) Inspired Oxygen concentration; (VII) Non-intubated thoracoscopic lobectomy; and (VIII) adjuvant pharmacologic options. The recommendations of class II are non-intubated thoracoscopic lobectomy may be an alternative to conventional one-lung ventilation in selected patients. The recommendations of class IIa are: (I) Therapeutic hypercapnia to maintain a partial pressure of carbon dioxide at 50-70 mmHg is reasonable for patients undergoing pulmonary lobectomy with one-lung ventilation; (II) PV with a tidal volume of 6 mL/kg and PEEP of 5 cmH2O are reasonable methods, based on current evidence; (III) alveolar recruitment [open lung ventilation (OLV)] may be beneficial in patients undergoing lobectomy with one-lung ventilation; (IV) PCV is recommended over VCV for patients undergoing lung resection; (V) pre- and post-operative CPAP can improve short-term oxygenation in patients undergoing lobectomy with one-lung ventilation; (VI) controlled mechanical ventilation with I:E ratio of 1:1 is reasonable in patients undergoing one-lung ventilation; (VII) use of lowest inspired oxygen concentration to maintain satisfactory arterial oxygen saturation is reasonable based on physiologic principles; (VIII) Adjuvant drugs such as nebulized budesonide, intravenous sivelestat and ulinastatin are reasonable and can be used to attenuate inflammatory response.",

keywords = "Guideline, Lobectomy, Mechanical ventilation, Tidal volume",

author = "Shugeng Gao and Zhongheng Zhang and Alessandro Brunelli and Chang Chen and Chun Chen and Gang Chen and Haiquan Chen and Chen, {Jin Shing} and Stephen Cassivi and Ying Chai and Downs, {John B.} and Wentao Fang and Xiangning Fu and Garutti, {Mart{\'i}nez I.} and Jianxing He and Jie He and Jian Hu and Yunchao Huang and Gening Jiang and Hongjing Jiang and Zhongmin Jiang and Danqing Li and Gaofeng Li and Hui Li and Qiang Li and Xiaofei Li and Yin Li and Zhijun Li and Liu, {Chia Chuan} and Deruo Liu and Lunxu Liu and Yongyi Liu and Haitao Ma and Weimin Mao and Yousheng Mao and Juwei Mou and Ng, {Calvin Sze Hang} and Petersen, {Ren{\'e} H.} and Guibin Qiao and Gaetano Rocco and Erico Ruffini and Lijie Tan and Qunyou Tan and Tang Tong and Haidong Wang and Qun Wang and Ruwen Wang and Shumin Wang and Deyao Xie and Qi Xue and Tao Xue and Lin Xu and Shidong Xu and Songtao Xu and Tiansheng Yan and Fenglei Yu and Zhentao Yu and Chunfang Zhang and Lanjun Zhang and Tao Zhang and Xun Zhang and Xiaojing Zhao and Xuewei Zhao and Xiuyi Zhi and Qinghua Zhou",

note = "Publisher Copyright: {\textcopyright} Journal of Thoracic Disease.",

year = "2017",

month = sep,

day = "1",

doi = "10.21037/jtd.2017.08.166",

language = "English (US)",

volume = "9",

pages = "3246--3254",

journal = "Journal of Thoracic Disease",

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TY - JOUR

T1 - The Society for Translational Medicine

T2 - Clinical practice guidelines for mechanical ventilation management for patients undergoing lobectomy

AU - Gao, Shugeng

AU - Zhang, Zhongheng

AU - Brunelli, Alessandro

AU - Chen, Chang

AU - Chen, Chun

AU - Chen, Gang

AU - Chen, Haiquan

AU - Chen, Jin Shing

AU - Cassivi, Stephen

AU - Chai, Ying

AU - Downs, John B.

AU - Fang, Wentao

AU - Fu, Xiangning

AU - Garutti, Martínez I.

AU - He, Jianxing

AU - He, Jie

AU - Hu, Jian

AU - Huang, Yunchao

AU - Jiang, Gening

AU - Jiang, Hongjing

AU - Jiang, Zhongmin

AU - Li, Danqing

AU - Li, Gaofeng

AU - Li, Hui

AU - Li, Qiang

AU - Li, Xiaofei

AU - Li, Yin

AU - Li, Zhijun

AU - Liu, Chia Chuan

AU - Liu, Deruo

AU - Liu, Lunxu

AU - Liu, Yongyi

AU - Ma, Haitao

AU - Mao, Weimin

AU - Mao, Yousheng

AU - Mou, Juwei

AU - Ng, Calvin Sze Hang

AU - Petersen, René H.

AU - Qiao, Guibin

AU - Rocco, Gaetano

AU - Ruffini, Erico

AU - Tan, Lijie

AU - Tan, Qunyou

AU - Tong, Tang

AU - Wang, Haidong

AU - Wang, Qun

AU - Wang, Ruwen

AU - Wang, Shumin

AU - Xie, Deyao

AU - Xue, Qi

AU - Xue, Tao

AU - Xu, Lin

AU - Xu, Shidong

AU - Xu, Songtao

AU - Yan, Tiansheng

AU - Yu, Fenglei

AU - Yu, Zhentao

AU - Zhang, Chunfang

AU - Zhang, Lanjun

AU - Zhang, Tao

AU - Zhang, Xun

AU - Zhao, Xiaojing

AU - Zhao, Xuewei

AU - Zhi, Xiuyi

AU - Zhou, Qinghua

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Patients undergoing lobectomy are at significantly increased risk of lung injury. One-lung ventilation is the most commonly used technique to maintain ventilation and oxygenation during the operation. It is a challenge to choose an appropriate mechanical ventilation strategy to minimize the lung injury and other adverse clinical outcomes. In order to understand the available evidence, a systematic review was conducted including the following topics: (I) protective ventilation (PV); (II) mode of mechanical ventilation [e.g., volume controlled (VCV) versus pressure controlled (PCV)]; (III) use of therapeutic hypercapnia; (IV) use of alveolar recruitment (open-lung) strategy; (V) pre-and post-operative application of positive end expiratory pressure (PEEP); (VI) Inspired Oxygen concentration; (VII) Non-intubated thoracoscopic lobectomy; and (VIII) adjuvant pharmacologic options. The recommendations of class II are non-intubated thoracoscopic lobectomy may be an alternative to conventional one-lung ventilation in selected patients. The recommendations of class IIa are: (I) Therapeutic hypercapnia to maintain a partial pressure of carbon dioxide at 50-70 mmHg is reasonable for patients undergoing pulmonary lobectomy with one-lung ventilation; (II) PV with a tidal volume of 6 mL/kg and PEEP of 5 cmH2O are reasonable methods, based on current evidence; (III) alveolar recruitment [open lung ventilation (OLV)] may be beneficial in patients undergoing lobectomy with one-lung ventilation; (IV) PCV is recommended over VCV for patients undergoing lung resection; (V) pre- and post-operative CPAP can improve short-term oxygenation in patients undergoing lobectomy with one-lung ventilation; (VI) controlled mechanical ventilation with I:E ratio of 1:1 is reasonable in patients undergoing one-lung ventilation; (VII) use of lowest inspired oxygen concentration to maintain satisfactory arterial oxygen saturation is reasonable based on physiologic principles; (VIII) Adjuvant drugs such as nebulized budesonide, intravenous sivelestat and ulinastatin are reasonable and can be used to attenuate inflammatory response.

AB - Patients undergoing lobectomy are at significantly increased risk of lung injury. One-lung ventilation is the most commonly used technique to maintain ventilation and oxygenation during the operation. It is a challenge to choose an appropriate mechanical ventilation strategy to minimize the lung injury and other adverse clinical outcomes. In order to understand the available evidence, a systematic review was conducted including the following topics: (I) protective ventilation (PV); (II) mode of mechanical ventilation [e.g., volume controlled (VCV) versus pressure controlled (PCV)]; (III) use of therapeutic hypercapnia; (IV) use of alveolar recruitment (open-lung) strategy; (V) pre-and post-operative application of positive end expiratory pressure (PEEP); (VI) Inspired Oxygen concentration; (VII) Non-intubated thoracoscopic lobectomy; and (VIII) adjuvant pharmacologic options. The recommendations of class II are non-intubated thoracoscopic lobectomy may be an alternative to conventional one-lung ventilation in selected patients. The recommendations of class IIa are: (I) Therapeutic hypercapnia to maintain a partial pressure of carbon dioxide at 50-70 mmHg is reasonable for patients undergoing pulmonary lobectomy with one-lung ventilation; (II) PV with a tidal volume of 6 mL/kg and PEEP of 5 cmH2O are reasonable methods, based on current evidence; (III) alveolar recruitment [open lung ventilation (OLV)] may be beneficial in patients undergoing lobectomy with one-lung ventilation; (IV) PCV is recommended over VCV for patients undergoing lung resection; (V) pre- and post-operative CPAP can improve short-term oxygenation in patients undergoing lobectomy with one-lung ventilation; (VI) controlled mechanical ventilation with I:E ratio of 1:1 is reasonable in patients undergoing one-lung ventilation; (VII) use of lowest inspired oxygen concentration to maintain satisfactory arterial oxygen saturation is reasonable based on physiologic principles; (VIII) Adjuvant drugs such as nebulized budesonide, intravenous sivelestat and ulinastatin are reasonable and can be used to attenuate inflammatory response.

KW - Guideline

KW - Lobectomy

KW - Mechanical ventilation

KW - Tidal volume

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The Society for Translational Medicine: Clinical practice guidelines for mechanical ventilation management for patients undergoing lobectomy

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Keywords

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