Postoperative pulmonary complications are a common problem in at-risk surgical patients despite that lung protective ventilation (LPV) has decreased its prevalence. These complications are associated with worse prognosis, and an increase in hospital length-of stay (LOS) and mortality.
Some different strategies, such as intraoperative open-lung approach (OLA) or high-flow nasal cannula (HFNC) in the postoperative period have shown to decrease postoperative pulmonary complications. However, no studies have evaluated these strategies when applied together.
In the iPROVE-OLV study we hypothesize that perioperative management including an intraoperative OLA (using low tidal volume, alveolar recruitment maneuvers, individualized positive end-expiratory pressure) followed by individually apply postoperative HFNC will decrease postoperative complications, unplanned readmission, ICU and hospital LOS, and mortality compared to a standardized LPV in high-risk surgical patients.
To examine our hypothesis, we will perform an international multicenter randomized, controlled clinical trial in 1380 patients scheduled to thoracic surgery admitted in a network of International hospitals.