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Conventional Ventilation vs Protective Strategies for Thoracic SurgeryProtective Ventilation: Overly Beneficial Results?: The Results May Be Too Good to Be True FREE TO VIEW

Alimorad Djalali, MD, PhD
Author and Funding Information

From the Department of Anesthesia, Stanford University.

Correspondence to: Alimorad Djalali, MD, PhD, Department of Anesthesia, Stanford University, 300 Pasteu Dr, Room H3687, MC 5640, Stanford, CA 94305; e-mail: adjalali@stanford.edu

Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1668-1669. doi:10.1378/chest.11-1791
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To the Editor:

In a recent issue of CHEST (March 2011), Yang et al1 demonstrated a surprisingly clear benefit of protective-ventilation strategy compared with conventional ventilation (CV) for thoracic surgical procedures in a small sample of patients. With 50 patients in each study arm, they demonstrated a 22% rate of pulmonary dysfunction in the conventional group vs 4% in the protective-ventilation cohort. Yet, serious problems with randomization and study design cast some doubts over the suggestive results. In the CV group, the majority of the procedures (>50%) were performed by one surgeon. In addition, in the same group, <40% of the patients (vs 60% in the protective ventilation group) had an epidural for postoperative pain management, making the two groups almost incomparable.2 Furthermore, in 30% of the patients in the CV group, a change in ventilation mode was necessary for the continuation of the procedures. Too many variables, such as Fio2, positive end-expiratory pressure, mode of ventilation, postoperative pain management, open vs video-assisted operation, and so forth, make a statement about the advantage of one strategy over the other nearly impossible.3 Although Yang et al1 intended to show some evidence in favor of a protective strategy, the jury on this issue is still out.

Yang M, Ahn HJ, Kim K, et al. Does a protective ventilation strategy reduce the risk of pulmonary complications after lung cancer surgery? A randomized controlled trial. Chest. 2011;1393:530-537 [CrossRef] [PubMed]
 
Bland JM, Altman DG. One and two sided tests of significance. BMJ. 1994;3096949:248 [CrossRef] [PubMed]
 
Hulley SB. Designing Clinical Research. 2007;3rd ed Philadelphia, PA Lippincott Williams & Wilkins
 

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References

Yang M, Ahn HJ, Kim K, et al. Does a protective ventilation strategy reduce the risk of pulmonary complications after lung cancer surgery? A randomized controlled trial. Chest. 2011;1393:530-537 [CrossRef] [PubMed]
 
Bland JM, Altman DG. One and two sided tests of significance. BMJ. 1994;3096949:248 [CrossRef] [PubMed]
 
Hulley SB. Designing Clinical Research. 2007;3rd ed Philadelphia, PA Lippincott Williams & Wilkins
 
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