Cardiothoracic & vascular anesthesia
Postoperative Outcomes Following Prolonged One-Lung Ventilation in Thoracic Surgery in Relation to Intraoperative Ventilation Practice: A Registry-Based Multicenter Study
Authors' conclusion
Several pressure-, volume-, and duration-related thresholds were associated with higher postoperative morbidity and in-hospital mortality in unadjusted analyses.
Study context
- Population
- Patients undergoing thoracic surgery with one-lung ventilation (OLV) >60 minutes, German Thorax Registry, 2016–2021
- Participants
- 2,026 patients
- Exposure
- Intraoperative ventilation parameter thresholds (driving pressure (DP), pMax, positive end-expiratory pressure (PEEP), tidal volume (TV)/predicted body weight (PBW)) and OLV/surgery duration during prolonged OLV
- Outcome
- Overall postoperative complications and respiratory complications
Methodological detailsmulticentre, registry-based
- Multicentre
- Registry-based
Main finding
As reported in the abstract
- Overall postoperative complications (incidence)
- 34.1%
- Respiratory complications (incidence)
- 18.6%
- Higher overall complication rates with DP >20 mbar, pMax >25 and >30 mbar, PEEP >7 and >8 mbar, TV/PBW >4 and >5 mL/kg PBW
- all p < 0.05
- Higher overall complication rates with OLV duration >180 vs 61 to 90 minutes and surgery duration >180 vs 31 to 60 minutes
- both p < 0.001
- Respiratory complications associated with DP >20 mbar
- p = 0.009
- Respiratory complications associated with DP >25 mbar
- p = 0.013
- Respiratory complications associated with pMax >25 mbar
- p < 0.001
- Respiratory complications associated with pMax >30 mbar
- p = 0.022
- Respiratory complications associated with TV >5 mL/kg PBW
- p = 0.032
- Higher respiratory complication rates with OLV duration >180 vs 61 to 90 minutes and surgery duration >180 vs 31 to 60 minutes
- both p < 0.001
Observational data: associations, not effects.
Secondary outcomes
- In-hospital mortality (incidence)
- 1.8%
- Associated with DP >20 mbar
- P = 0.023
- Associated with pMax >25 mbar
- P = 0.017
- Associated with pMax >30 mbar
- P < 0.001
- Associated with PEEP >8 mbar
- P = 0.027
- Associated with TV >8 mL/kg PBW
- P = 0.034
- Limited by low number of events (n = 37)
Original publication
Postoperative Outcomes Following Prolonged One-Lung Ventilation in Thoracic Surgery in Relation to Intraoperative Ventilation Practice: A Registry-Based Multicenter Study. J Cardiothorac Vasc Anesth. Published 1 July 2026. doi:10.
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