High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial

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dc.contributor.authorHemmes, Sabrine N. T.
dc.contributor.authorde Abreu, Marcelo Gama
dc.contributor.authorPelosi, Paolo
dc.contributor.authorSchultz, Marcus J.
dc.contributor.authorSevergnini, Paolo
dc.contributor.authorHollmann, Markus W.
dc.contributor.authorBinnekade, Jan M.
dc.contributor.authorWrigge, Hermann
dc.contributor.authorCanet, Jaume
dc.contributor.authorHiesmayr, Michael
dc.contributor.authorSchmid, Werner
dc.contributor.authorJaber, Samir
dc.contributor.authorHedenstierna, Goran
dc.contributor.authorPutensen, Christian
dc.contributor.authorSessler, Daniel I.
dc.contributor.authorLachmann, Burkhard
dc.contributor.authorKacmarek, Robert M.
dc.contributor.authorSlutsky, Arthur S.
dc.contributor.authorDe Baerdemaeker, Luc
dc.contributor.authorDe Hert, Stefan
dc.contributor.authorHeyse, Bjorn
dc.contributor.authorVan Limmen, Jurgen
dc.contributor.authorMulier, Jan-Paul
dc.contributor.authorVelghe, David
dc.contributor.authorJamaer, Luc
dc.contributor.authorVandenbrande, Jeroen
dc.contributor.authorBugedo, Guillermo
dc.contributor.authorFlorez, Jorge
dc.contributor.authorGoranovic, Tatjana
dc.contributor.authorMazul-Sunko, Branka
dc.contributor.authorBluth, Thomas
dc.contributor.authorGuldner, Andreas
dc.contributor.authorKiss, Thomas
dc.contributor.authorKoch, Thea
dc.contributor.authorSpieth, Peter Markus
dc.contributor.authorUhlig, Christopher
dc.contributor.authorYaqub, Jonathan
dc.contributor.authorBastin, Bea
dc.contributor.authorGeib, Johann
dc.contributor.authorSchaefer, Maximilian S.
dc.contributor.authorWeiss, Martin
dc.contributor.authorTreschan, Tanja A.
dc.contributor.authorReske, Andreas W.
dc.contributor.authorSimon, Philipp
dc.contributor.authorFerner, Alexander Brodhun Marion
dc.contributor.authorHartmann, Eric
dc.contributor.authorLaufenberg-Feldmann, Rita
dc.contributor.authorStrys, Lydia
dc.contributor.authorDe Robertis, Edoardo
dc.contributor.authorPerilli, Valter
dc.contributor.authorProietti, Rodolfo
dc.contributor.authorAmantea, Bruno
dc.contributor.authorCaroleo, Santo
dc.contributor.authorTropea, Francesco
dc.contributor.authorBacuzzi, Alessandro
dc.contributor.authorVanoni, Massimo
dc.contributor.authorCinnella, Gilda
dc.contributor.authorCaggianelli, Girolamo
dc.contributor.authorD'Antini, Davide
dc.contributor.authorLa Bella, Daniela
dc.contributor.authorMollica, Giuseppina
dc.contributor.authorCortegiani, Andrea
dc.contributor.authorGiarratano, Antonino
dc.contributor.authorMontalto, Francesca
dc.contributor.authorRaineri, Santi Maurizio
dc.contributor.authorBarberis, Bruno
dc.contributor.authorCelentano, Cristian
dc.contributor.authorGrio, Michele
dc.contributor.authorSpagnolo, Luigi
dc.contributor.authorGratarola, Angelo
dc.contributor.authorMolin, Alexandre
dc.contributor.authorPellerano, Giulia
dc.contributor.authorPezzato, Stefano
dc.contributor.authorRusca, Roberta
dc.contributor.authorDella Rocca, Giorgio
dc.contributor.authorBos, Lieuwe D. J.
dc.contributor.authorBrunelli, Andrea
dc.contributor.authorMarti, Agnes
dc.contributor.authorCegarra, Virginia
dc.contributor.authorMerten, Alfred
dc.contributor.authorVictoria Moral, Maria
dc.contributor.authorParera, Ana
dc.contributor.authorCarmen Unzueta, Maria
dc.contributor.authorSabate, Sergi
dc.contributor.authorSierra, Pilar
dc.contributor.authorMayoral, Juan F.
dc.contributor.authorPrieto, Merce
dc.contributor.authorGranell Gil, Manuel
dc.contributor.authorMinguez Marin, Conrado
dc.contributor.authorMills, Gary H.
dc.contributor.authorBodger, Phoebe
dc.contributor.authorMelo, Marcos F. Vidal
dc.contributor.authorSulemanji, Demet
dc.contributor.authorSprung, Juraj
dc.contributor.authorDe Bruyne, Ann
dc.contributor.authorOngena, Patricia
dc.contributor.authorBleyl, Jorg-Uwe
dc.contributor.authorKoch, Moritz
dc.contributor.authorMuller, Michael
dc.contributor.authorRossel, Thomas
dc.contributor.authorSaeger, Hans-Detlef
dc.contributor.authorWeitz, Jurgen
dc.contributor.authorBabian, Renate
dc.contributor.authorRathmann, Anna Malina
dc.contributor.authorPochert, Julia
dc.contributor.authorDathe, Mandy
dc.contributor.authorChiaravalloti, Fernando
dc.contributor.authorMadia, Daniela
dc.contributor.authorPezzoli, Ivana
dc.contributor.authorCaruso, Andrea
dc.contributor.authorBianco, Maria Francesca
dc.contributor.authorPicicco, Francesco
dc.contributor.authorMirabella, Lucia
dc.contributor.authorRauseo, Michela
dc.contributor.authorAnguilano, Romina
dc.contributor.authorPalmeri, Cesira
dc.contributor.authorStrano, Maria Teresa
dc.contributor.authorFederico, Antonino
dc.contributor.authorPompei, Livia
dc.contributor.authorButtera, Stefania
dc.contributor.authorEveringham, Kirsty
dc.contributor.authorHan, Ruth
dc.contributor.authorHewson, Russell
dc.contributor.authorJanuszewska, Marta
dc.contributor.authorMohr, Otto
dc.contributor.authorPearse, Rupert
dc.contributor.authorRaj, Ashok
dc.contributor.authorOto, Jun
dc.contributor.authorKacmarek, Robert M.
dc.contributor.authorWeingarten, Toby N.
dc.date.accessioned2025-01-23T21:43:45Z
dc.date.available2025-01-23T21:43:45Z
dc.date.issued2014
dc.description.abstractBackground The role of positive end-expiratory pressure in mechanical ventilation during general anaesthesia for surgery remains uncertain. Levels of pressure higher than 0 cm H2O might protect against postoperative pulmonary complications but could also cause intraoperative circulatory depression and lung injury from overdistension. We tested the hypothesis that a high level of positive end-expiratory pressure with recruitment manoeuvres protects against postoperative pulmonary complications in patients at risk of complications who are receiving mechanical ventilation with low tidal volumes during general anaesthesia for open abdominal surgery.
dc.description.abstractMethods In this randomised controlled trial at 30 centres in Europe and North and South America, we recruited 900 patients at risk for postoperative pulmonary complications who were planned for open abdominal surgery under general anaesthesia and ventilation at tidal volumes of 8 mL/kg. We randomly allocated patients to either a high level of positive end-expiratory pressure (12 cm H2O) with recruitment manoeuvres (higher PEEP group) or a low level of pressure (<= 2 cm H2O) without recruitment manoeuvres (lower PEEP group). We used a centralised computer-generated randomisation system. Patients and outcome assessors were masked to the intervention. Primary endpoint was a composite of postoperative pulmonary complications by postoperative day 5. Analysis was by intention-to-treat. The study is registered at Controlled-Trials. com, number ISRCTN70332574.
dc.description.abstractFindings From February, 2011, to January, 2013, 447 patients were randomly allocated to the higher PEEP group and 453 to the lower PEEP group. Six patients were excluded from the analysis, four because they withdrew consent and two for violation of inclusion criteria. Median levels of positive end-expiratory pressure were 12 cm H2O (IQR 12-12) in the higher PEEP group and 2 cm H2O (0-2) in the lower PEEP group. Postoperative pulmonary complications were reported in 174 (40%) of 445 patients in the higher PEEP group versus 172 (39%) of 449 patients in the lower PEEP group (relative risk 1.01; 95% CI 0.86-1.20; p = 0.86). Compared with patients in the lower PEEP group, those in the higher PEEP group developed intraoperative hypotension and needed more vasoactive drugs.
dc.description.abstractInterpretation A strategy with a high level of positive end-expiratory pressure and recruitment manoeuvres during open abdominal surgery does not protect against postoperative pulmonary complications. An intraoperative protective ventilation strategy should include a low tidal volume and low positive end-expiratory pressure, without recruitment manoeuvres.
dc.fuente.origenWOS
dc.identifier.doi10.1016/S0140-6736(14)60416-5
dc.identifier.eissn1474-547X
dc.identifier.issn0140-6736
dc.identifier.urihttps://doi.org/10.1016/S0140-6736(14)60416-5
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/101682
dc.identifier.wosidWOS:000340198300028
dc.issue.numero9942
dc.language.isoen
dc.pagina.final503
dc.pagina.inicio495
dc.revistaLancet
dc.rightsacceso restringido
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleHigh versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial
dc.typeartículo
dc.volumen384
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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