Flow‐controlled expiration improves gas exchange in anaesthetised horses undergoing orthopaedic surgery

Background Flow‐controlled expiration (FLEX) has been shown to significantly enhance oxygenation in horses under laboratory conditions. Objective This study aims to corroborate these findings by evaluating the effects of FLEX on gas exchange in a randomised clinical trial involving a large population of clinical horses undergoing orthopaedic surgery. Study Design Prospective randomised clinical trial. Methods A total of 406 healthy adult horses scheduled for elective orthopaedic procedures were recruited for this prospective clinical trial. Horses were randomly assigned to FLEX or VCV (volume‐controlled ventilation) groups in dorsal (VCV‐D and FLEX‐D) or lateral recumbency (VCV‐L and FLEX‐L). Arterial blood gases were measured at 30, 75, and 120 min post‐induction to assess arterial oxygenation (arterial partial pressure of oxygen to inspired fraction of oxygen ratio, PaO 2 /FiO 2 ). A global index of ventilation/perfusion matching ([PaCO 2 − ETCO 2 ]/PaCO 2 ) was also calculated. Peak airway pressure (P peak ) and tidal volume were measured to calculate dynamic respiratory system compliance (Cdyn). Data were compared with repeated‐measures ANOVA. Results Horses ventilated with FLEX showed significantly higher PaO 2 /FiO 2 (FLEX‐D vs. VCV‐D, 369 ± 42 vs. 198 ± 112 mmHg, p < 0.001; FLEX‐L vs. VCV‐L, 436 ± 38 vs. 249 ± 88 mmHg, p < 0.001). FLEX also improved Cdyn (FLEX‐D vs. VCV‐D, 0.81 ± 0.1 vs. 0.64 ± 0.12, p = 0.01) and the global V̇/Q̇ index ([PaCO 2 − ETCO 2 ]/PaCO 2 ) (FLEX‐D vs. VCV‐D, 0.11 ± 0.03 vs. 0.18 ± 0.03, p = 0.03) in dorsal‐positioned but not lateral‐positioned horses. Main Limitations Anaesthesia protocols were not standardised; anaesthetists were not masked to the intervention of interest, and findings may not be generalisable to other patient populations. Conclusions These results confirm previous laboratory findings, demonstrating that FLEX improves oxygenation, ventilation–perfusion matching, and respiratory mechanics compared to VCV in a large clinical population of anaesthetised horses.