Key result
Lung-protective ventilation increases postoperative albumin excretion ~53% versus conventional ventilation in robotic prostatectomy.
Why the study?
Lung protective ventilation with low tidal volume and increased PEEP may have unfavorable cardiovascular effects, but its impact on hemodynamic, renal, and hormonal variables is unclear.
Does lung protective ventilation with low tidal volume and high PEEP alter hemodynamic, renal, and hormonal variables in patients undergoing robot-assisted radical prostatectomy?
RCT (n=24)
Single-blind
Simple envelope method
No
Does lung protective ventilation with low tidal volume and high PEEP alter hemodynamic, renal, and hormonal variables in patients undergoing robot-assisted radical prostatectomy?
Lung protective ventilation during robot-assisted radical prostatectomy is associated with minor postoperative increases in BNP and albumin excretion, while the surgical procedure itself causes a transient reduction in renal function.
Lung protective ventilation may confer minor postoperative hemodynamic and renal effects; leaves open clinical relevance pending larger primary-outcome trials.
Background Lung protective ventilation with low tidal volume (TV) and increased positive end-expiratory pressure (PEEP) can have unfavorable effects on the cardiovascular system. We aimed to investigate whether lung protective ventilation has adverse impact on hemodynamic, renal and hormonal variables. Methods In this randomized, single-blinded, placebo-controlled study, 24 patients scheduled for robot-assisted radical prostatectomy were included. Patients were equally randomized to receive either ventilation with a TV of 6 ml/IBW and PEEP of 10 cm H2O (LTV-h.PEEP) or ventilation with a TV of 10 ml/IBW and PEEP of 4 cm H2O (HTV-l.PEEP). Before, during and after surgery, hemodynamic variables were measured, and blood and urine samples were collected. Blood samples were analyzed for plasma concentrations of electrolytes and vasoactive hormones. Urine samples were analyzed for excretions of electrolytes and markers of nephrotoxicity. Results Comparable variables were found among the two groups, except for significantly higher postoperative levels of plasma brain natriuretic peptide (p = 0.033), albumin excretion (p = 0.012) and excretion of epithelial sodium channel (p = 0.045) in the LTV-h.PEEP ventilation group compared to the HTV-l.PEEP ventilation group. In the combined cohort, we found a significant decrease in creatinine clearance (112.0 [83.4;126.7] ml/min at baseline vs. 45.1 [25.4;84.3] ml/min during surgery) and a significant increase in plasma concentrations of renin, angiotensin II, and aldosterone. Conclusion Lung protective ventilation was associated with minor adverse hemodynamic and renal effects postoperatively. All patients showed a substantial but transient reduction in renal function accompanied by activation of the renin-angiotensin-aldosterone system. Trial registration ClinicalTrials, NCT02551341 . Registered 13 September 2015.
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Høyer et al. (2021) conducted an RCT in Prostate cancer (scheduled for robot-assisted radical prostatectomy) (n=24). Lung protective ventilation (LTV-h.PEEP) vs. High tidal volume, low PEEP (HTV-l.PEEP) ventilation (TV 10 ml/IBW, PEEP 4 cm H2O) was evaluated on Urine albumin creatinine ratio (UACR) at day 2 postoperatively (secondary outcome of main trial) (p=0.012). Lung protective ventilation during robot-assisted radical prostatectomy was associated with minor adverse effects, including significantly higher postoperative albumin excretion and plasma brain natriuretic peptide compared to conventional ventilation.
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