Pub Date : 2025-11-27DOI: 10.1016/s2213-2600(25)00371-6
Cassidy Du Berry, Diane M Gray, Amber Bates, Darweeza Salaam-Geydien, Lex W Doyle, Shannon J Simpson
Preterm birth is increasingly recognised as adversely influencing lifelong lung function. This Series paper on prematurity-associated lung disease reviews studies reporting longitudinal lung function measurements in individuals who were born preterm. Evidence suggests that preterm birth alters lung function trajectories from early life onwards, with implications for future respiratory morbidity. We propose that this population needs rigorous follow up that should include systematic monitoring of lung function across the lifespan, starting in childhood. Key priorities include understanding risk factors for poor lung function trajectories and moving beyond bronchopulmonary dysplasia alone to establish the phenotype of individuals who were born preterm that are at increased risk of poor trajectory more precisely. Novel approaches, including data-driven analytics and large-scale collaborative studies, will be essential to define phenotypes and trajectories of prematurity-associated lung disease more robustly. Finally, we highlight the need for interventional studies to establish whether adverse lung function trajectories can be stabilised or improved, thereby reducing risk of early chronic obstructive pulmonary disease (ie, diagnosis at age <50 years).
{"title":"Trajectories of prematurity-associated lung disease: lifelong lung health","authors":"Cassidy Du Berry, Diane M Gray, Amber Bates, Darweeza Salaam-Geydien, Lex W Doyle, Shannon J Simpson","doi":"10.1016/s2213-2600(25)00371-6","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00371-6","url":null,"abstract":"Preterm birth is increasingly recognised as adversely influencing lifelong lung function. This Series paper on prematurity-associated lung disease reviews studies reporting longitudinal lung function measurements in individuals who were born preterm. Evidence suggests that preterm birth alters lung function trajectories from early life onwards, with implications for future respiratory morbidity. We propose that this population needs rigorous follow up that should include systematic monitoring of lung function across the lifespan, starting in childhood. Key priorities include understanding risk factors for poor lung function trajectories and moving beyond bronchopulmonary dysplasia alone to establish the phenotype of individuals who were born preterm that are at increased risk of poor trajectory more precisely. Novel approaches, including data-driven analytics and large-scale collaborative studies, will be essential to define phenotypes and trajectories of prematurity-associated lung disease more robustly. Finally, we highlight the need for interventional studies to establish whether adverse lung function trajectories can be stabilised or improved, thereby reducing risk of early chronic obstructive pulmonary disease (ie, diagnosis at age <50 years).","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"175 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145611733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-25DOI: 10.1016/s2213-2600(25)00401-1
Eugenio De Corso, G Walter Canonica, Enrico Heffler
{"title":"EVEREST and the eosinophil paradox – Authors' reply","authors":"Eugenio De Corso, G Walter Canonica, Enrico Heffler","doi":"10.1016/s2213-2600(25)00401-1","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00401-1","url":null,"abstract":"","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"27 1","pages":"e61"},"PeriodicalIF":76.2,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145600091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-25DOI: 10.1016/s2213-2600(25)00362-5
Hnin W W Aung, Kristina Vermeersch, Hamish J C McAuley, Sanjay Ramakrishnan, Mustafa Abdo, Amber Beersaerts, Steven P Cass, Nicola Smallcombe, Iwein Gyselinck, Hendrik Pott, Tom J C Ward, Adam K A Wright, Christopher E Brightling, Pierre-Régis Burgel, Marco Contoli, Frits M E Franssen, Arturo Huerta, Jennifer K Quint, Bernd Schmeck, Lowie E G W Vanfleteren, Neil J Greening
Exacerbations punctuate the natural course of chronic obstructive pulmonary disease (COPD), posing a substantial burden on patients and health-care systems. Understanding the severity of an acute exacerbation of COPD (AECOPD) is crucial for stratifying mortality risk and guiding treatment decisions. Currently, the severity of an AECOPD is primarily graded on outcomes of health-care use. Given the complex heterogeneity in pathogenesis, clinical presentation, post-event trajectory, and patient perspectives, this approach does not adequately address the causes and extent of clinical deterioration or consider an individual's baseline status, upon which implementation of treatment and prevention of future exacerbations rely. We have conceptualised a multidimensional model to stratify the severity and prognostic risk of an AECOPD, incorporating three distinct domains: baseline functional status (B), the intensity of the event (acuity; A), and the causal trigger (t). The BAt classification for AECOPD could allow for more individualised prognostic and therapeutic implications. The validation process for this model is underway, with preliminary findings supporting its feasibility.
{"title":"Multidimensional prognostic risk stratification of COPD exacerbations: the baseline, acuity, and trigger (BAt) model","authors":"Hnin W W Aung, Kristina Vermeersch, Hamish J C McAuley, Sanjay Ramakrishnan, Mustafa Abdo, Amber Beersaerts, Steven P Cass, Nicola Smallcombe, Iwein Gyselinck, Hendrik Pott, Tom J C Ward, Adam K A Wright, Christopher E Brightling, Pierre-Régis Burgel, Marco Contoli, Frits M E Franssen, Arturo Huerta, Jennifer K Quint, Bernd Schmeck, Lowie E G W Vanfleteren, Neil J Greening","doi":"10.1016/s2213-2600(25)00362-5","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00362-5","url":null,"abstract":"Exacerbations punctuate the natural course of chronic obstructive pulmonary disease (COPD), posing a substantial burden on patients and health-care systems. Understanding the severity of an acute exacerbation of COPD (AECOPD) is crucial for stratifying mortality risk and guiding treatment decisions. Currently, the severity of an AECOPD is primarily graded on outcomes of health-care use. Given the complex heterogeneity in pathogenesis, clinical presentation, post-event trajectory, and patient perspectives, this approach does not adequately address the causes and extent of clinical deterioration or consider an individual's baseline status, upon which implementation of treatment and prevention of future exacerbations rely. We have conceptualised a multidimensional model to stratify the severity and prognostic risk of an AECOPD, incorporating three distinct domains: baseline functional status (B), the intensity of the event (acuity; A), and the causal trigger (t). The BAt classification for AECOPD could allow for more individualised prognostic and therapeutic implications. The validation process for this model is underway, with preliminary findings supporting its feasibility.","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"5 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145600090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-21DOI: 10.1016/s2213-2600(25)00392-3
Arzu Yorgancioğlu
{"title":"A call to action: environmental and climate impacts on asthma","authors":"Arzu Yorgancioğlu","doi":"10.1016/s2213-2600(25)00392-3","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00392-3","url":null,"abstract":"","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"30 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145560172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-19DOI: 10.1016/s2213-2600(25)00427-8
Peter Ranscombe
{"title":"Telling “stories of breath” to make asthma visible","authors":"Peter Ranscombe","doi":"10.1016/s2213-2600(25)00427-8","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00427-8","url":null,"abstract":"","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"167 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145545434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"From asthma theory to practice: insights from real life","authors":"Alessandra Tomasello, Alida Benfante, Nicola Scichilone","doi":"10.1016/s2213-2600(25)00394-7","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00394-7","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"219 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-12DOI: 10.1016/s2213-2600(25)00330-3
Jeroen Abbenhuis, Ahmed Abdulmomen, Asead Abdyli, Mohamed M. Abu Elyazed, Pilar Aguirre Puig, Ilknur Hatice Akbudak, Can Aksu, Ali Alagöz, Malik Alhamdi, Shams Almadhati, Nasser K Altorki, Sonsoles Aragón Alvarez, Oguzhan Arun, Mustafa Azizoglu, Wolfgang Baar, Detlef Balde, Boglárka Balla, Merve Balli Seker, Musaab Basheer, Wolfgang O Bauer, Johan Bence, Martin H. Bernardi, Luca M. Bigatello, Elena Bignami, Thomas Bluth, Iwona Bonney, Belaid Bouhemad, Nikola Bradic, Luigi Brescianini, Jan Bruthans, Carolien S.E. Bulte, Genoveva Cadar, Gul Cakmak, Placido Calì, Leonarda Pia Cantatore, Xiaoqing Chai, Yi-Ting Chang, Jiaqi Chen, Maria Christofaki, Gilda Cinnella, Luciana Coelho Sanches, Ana Constantin, Victor Contreras, Laura Corsi, Eduardo da Silva, Jérôme Defosse, Raffaele Deluca, John Diaper, Loes Didden, Evanthia Dimitriou, Paulo do Nascimento Junior, Rudin Domi, Laurin Dorfinger, Luiz Fernando dos Reis Falcão, Christian Douradinho, Mojca Drnovšek Globokar, Ferdane Melike Duran, Abdelazeem Eldawlatly, Hala M. El-Gendy, Maram I. Elmazny, Salah-Eldin I. Elsherif, Moataz Maher Emara, Sharon Thali Enriquez de los Santos, Sarah Farnell-Ward, Renan Ferrufino, Marcelo Gama de Abreu, Lingling Gao, Dogu Geyik, Deja Gnezda, Steffie Goeden, Kristina Gorjup, Manuel Granell Gil, Ricardo Eli Guido Guerra, Maísa Guimarães de Castro Pereira, Pierre-Grégoire Guinot, Aysegul Guven, Helmut Hager, Ling Han, Zehra Hatipoglu, Megumi Hayashi, Johannes Hell, Jan Hofland, Markus W Hollmann, Jicheng Hu, Kamil Hudácek, Gentian Huti, Monika Ilic, Radmilo J Jankovic, Anita Jegarl, María-José Jiménez Andújar, Danfeng Jin, Tobias Kammerer, Vjekoslav Karadža, Izumi Kawagoe, Seher Irem Kiran Paudel, Thomas Kiss, Thea Koch, Nevenka Kolaric, Nick J. Koning, Kostas Kostopanagiotou, Andreas Kostroglou, Petra Kovac, Tim Kramer, Jens Kraßler, Tom Kreft, Yagmur Kumrular, Marieke Kuut, Lan Lan, Pei-Ching Li, Xue-Fei Li, Lan-Tao Li, Marc Licker, Yujia Liu, Ferdinando Longo, Torsten Loop, Manuel López-Baamonde, Stéphane Luise, Wenchen Luo, Hu Lv, Maria de los Angeles Macias Jimenez, Danielle Dourado Magalhães, Matteo Martuscelli, Ana Mavko, Basak Ceyda Meco, Hasan Alp Mermer, Changhong Miao, Pavel Michálek, Gary H. Mills, Encarna Miñana Aragón, Lucia Mirabella, Matthew Molyneux, Luigi Montrano, Loreto Mosqueira, Jo Mourisse, Matthew T. Murrell, Ricard Navarro-Ripoll, Florica Negru, Vojislava Neskovic, Mario Nikolic, Juana Abigail Norberto de la Vega, Alberto Noto, Vasileia Nyktari, Mukadder Orhan Sungur, Levent Ozdemir, Agnese Ozolina, Tulun Ozturk, Maria Caterina Pace, Eugenio Pagnussatt Neto, Balázs Pálóczi, Alexandra Papaioannou, Konstantinos Papamichail, Nicolò Patroniti, Yaser Pektas, Denis Pereira Matalobos, Jasminka Peršec, Stanislava Petrovic, Dejan Pirc, Gints Plismanis, Cristina Prata Amendola, Marko Pražetina, Nevena Radovic, Michela Rauseo, Torsten Richter, Lorena Rivera Vallejo, Juan José Rodriguez Ruiz, Goran Rondovic, Jon Rosser, Fernando J. Sánchez García, Pasquale Sansone, Ayten Saracoglu, Kemal Tolga Saracoglu, Hilal Sazak, Martin Scharffenberg, Lorenzo Schiavoni, Thomas Schilling, Aras. Sediq, Axel Semmelmann, Nüzhet Mert Sentürk, Emre Sertaç Bingül, Gokhan Sertcakacilar, Eleni Sfika, Benjamin Shelley, Sul Hwa Shin, Tatiana Sidiropoulou, João M Silva-Jr, Laura Socci, Tania Socorro, Eleftheria Soulioti, Savino Spadaro, Jasna Špicek-Macan, Dominic Spray, Dusica Stamenkovic, Georgios Stefanakis, Radu Stoica, Milena Stojanovic, Pascal Stopora, Zerrin Sungur, Elizabete Svareniece-Karjaka, Katalin Szamos, Narcis-Valentin Tanase, Cagin Tanriverdi, Franz Tempel, Lotte E. Terwindt, Raphael Theilen, Danijela Tipura, Yasin Tire, Eleonora Tomaselli, Neusa Tsuguie Onari, Mehtap Tunç, Özlem Turhan, Mediha Turktan, Daniele Ugliola, Halim Ulugöl, Tamás Végh, Luigi Vetrugno, Costanza Vitali, Carlo Alberto Volta, Vera von Dossow, Gregory Voyagis, Gregory Voyagis, Rade Vukovic, Anita Z Vukovic, Reiner M. Waeschle, David Wall, Hui Wang, Di Wang, Dag Winroth, Jakob Wittenstein, Qichao Wu, Peiyao Xu, Olcay Yaldir, Esra Yamansavci Sirzai, Xinlu Yang, Davud Yapici, Ozgucan Yildirim, Cigdem Yildirim Guclu, Hai Yu, Selvinaz Yuksel Tanriverdi, Alexander Zarbock, Snjezana Zeba, Yue Zhang, Xue Zhang, Zhenyu Zhang, Jinlin Zhang, Gong-Wei Zhang, Jing Zhong, Sebastian Ziemann
<h3>Background</h3>The effect of higher positive end-expiratory pressure (PEEP) and recruitment manoeuvres aimed at lung expansion as compared with lower PEEP without recruitment manoeuvres aimed at permissive atelectasis on postoperative pulmonary complications (PPCs) in patients undergoing one-lung ventilation (OLV) during thoracic surgery is unclear. We aimed to determine the contribution of an intraoperative lung expansion strategy to preventing PPCs.<h3>Methods</h3>In this multicentre, randomised, controlled, international phase 3 trial (PROTHOR) conducted at 74 sites in 28 countries, we enrolled adult patients (aged ≥18 years) with a BMI of less than 35 kg/m<sup>2</sup> who were scheduled for open thoracic or video-assisted thoracoscopic surgery under general anaesthesia requiring one-lung ventilation with a double-lumen tube, with a planned operative time of more than 60 min, and an expected duration of one-lung ventilation longer than that of two-lung ventilation. Patients were randomly assigned (1:1), using permuted blocks of random size (4, 6, and 8) and stratified by study site, to receive one-lung ventilation with either a higher PEEP of 10 cm H<sub>2</sub>O and periodic lung recruitment manoeuvres (high PEEP group) or a lower PEEP of 5 cm H<sub>2</sub>O without routine recruitment manoeuvres (low PEEP group). All patients received protective tidal volumes of 5 mL/kg predicted body weight during one-lung ventilation and 7 mL/kg predicted body weight during two-lung ventilation. Postoperative assessors were masked to treatment allocation. The primary outcome was a composite of PPCs during the first 5 postoperative days, including aspiration pneumonia, moderate or severe respiratory failure, acute respiratory distress syndrome (ARDS), pulmonary infection, atelectasis, cardiopulmonary oedema, pleural effusion, non-operative pneumothorax, pulmonary infiltrates, prolonged air leak, purulent pleuritis, pulmonary embolism, and pulmonary haemorrhage. A modified intention-to-treat analysis was performed, with patients analysed according to their assigned treatment group, except in cases of withdrawal of informed consent, cancellation of surgery, and or loss to follow-up. This trial is registered with <span><span>ClinicalTrials.gov</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span> (<span><span>NCT02963025</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>) and is completed.<h3>Findings</h3>Between Jan 3, 2017, and Feb 12, 2024, 2200 patients were randomly allocated: 1099 to the high PEEP group and 1101 to the low PEEP group. 43 patients in the high PEEP group and 33 in the low PEEP group were excluded from the modified intentio
背景：胸外科手术中单肺通气（OLV）患者术后肺并发症（PPCs）的影响尚不清楚，与低呼气末正压（PEEP）和旨在肺扩张的吸气操作相比，低呼气末正压（PEEP）和无旨在容许性肺不张的吸气操作的效果。我们的目的是确定术中肺扩张策略对预防PPCs的贡献。这项多中心、随机、对照、国际3期试验（PROTHOR）在28个国家的74个地点进行，我们招募了BMI小于35 kg/m2的成年患者（年龄≥18岁），计划在全身麻醉下进行开腹或视频辅助胸腔镜手术，需要双腔管单肺通气，计划手术时间超过60分钟。单肺通气预期持续时间比双肺通气预期持续时间长。患者被随机分配（1:1），使用随机大小的排列块（4,6,8）并按研究地点分层，接受单肺通气，高PEEP组（高PEEP组）或低PEEP组（低PEEP组），高PEEP为10 cm H2O，并定期进行肺补充操作。所有患者在单肺通气期间接受5 mL/kg预测体重的保护潮气量，在双肺通气期间接受7 mL/kg预测体重的保护潮气量。术后评估人员不参与治疗分配。主要结局是术后前5天PPCs的综合结果，包括吸入性肺炎、中度或重度呼吸衰竭、急性呼吸窘迫综合征（ARDS）、肺部感染、肺不张、心肺水肿、胸腔积液、非手术性气胸、肺浸润、长时间漏气、化脓性胸膜炎、肺栓塞和肺出血。进行了改良的意向治疗分析，根据指定的治疗组对患者进行分析，撤回知情同意、取消手术和/或失去随访的情况除外。该试验已在ClinicalTrials.gov注册（NCT02963025）并已完成。在2017年1月3日至2024年2月12日期间，2200名患者被随机分配：1099名患者进入高PEEP组，1101名患者进入低PEEP组。随机化后，高PEEP组的43例患者和低PEEP组的33例患者被排除在改进的意向治疗分析之外。高PEEP组1036例患者中有555例（53.6%）出现主要结局，低PEEP组1049例患者中有592例（56.4%）出现主要结局（绝对风险差- 2.68个百分点[95% CI - 6.36 ~ 1.01]; p= 0.155）。高PEEP组972例患者中有484例（49.8%）出现术中并发症，低PEEP组974例患者中有305例（31.3%）出现术中并发症（绝对风险差18.09个百分点[95% CI 14.41 ~ 21.77]），其中，高PEEP组出现低血压（高PEEP组966例患者中有360例（37.3%）vs低PEEP组978例患者中有140例（14.3%））和新发心律失常（899例患者中有89例（9.9%）vs 956例患者中有37例（3.9%））较多。而低PEEP组低氧血症抢救动作更频繁（888例中29例[3.3%]vs 982例中86例[8.8%]）。术后出现肺外并发症的患者比例（1036例患者中110例[10.6%]vs 1049例患者中107例[10.2%]）和不良事件数量（209例vs 204例）在两组间无差异。解释：在接受胸外科手术的BMI小于35 kg/m2的患者中，与不进行通气的低PEEP相比，单肺通气采用高PEEP合并通气通气，并没有降低PPCs。术中肺扩张或容许性肺不张的选择应考虑个体的气体交换和血流动力学条件，这些条件在术中可能会有所不同。欧洲麻醉和重症监护学会资助临床试验网络；德国德累斯顿工业大学卡尔·古斯塔夫·卡鲁斯医院麻醉与重症监护科Universität（德累斯顿，德国）；国家环境保护协会Científico e Tecnológico （Brasília，巴西）；以及英国和爱尔兰麻醉师协会。
{"title":"Effects of intraoperative higher versus lower positive end-expiratory pressure during one-lung ventilation for thoracic surgery on postoperative pulmonary complications (PROTHOR): a multicentre, international, randomised, controlled, phase 3 trial","authors":"Jeroen Abbenhuis, Ahmed Abdulmomen, Asead Abdyli, Mohamed M. Abu Elyazed, Pilar Aguirre Puig, Ilknur Hatice Akbudak, Can Aksu, Ali Alagöz, Malik Alhamdi, Shams Almadhati, Nasser K Altorki, Sonsoles Aragón Alvarez, Oguzhan Arun, Mustafa Azizoglu, Wolfgang Baar, Detlef Balde, Boglárka Balla, Merve Balli Seker, Musaab Basheer, Wolfgang O Bauer, Johan Bence, Martin H. Bernardi, Luca M. Bigatello, Elena Bignami, Thomas Bluth, Iwona Bonney, Belaid Bouhemad, Nikola Bradic, Luigi Brescianini, Jan Bruthans, Carolien S.E. Bulte, Genoveva Cadar, Gul Cakmak, Placido Calì, Leonarda Pia Cantatore, Xiaoqing Chai, Yi-Ting Chang, Jiaqi Chen, Maria Christofaki, Gilda Cinnella, Luciana Coelho Sanches, Ana Constantin, Victor Contreras, Laura Corsi, Eduardo da Silva, Jérôme Defosse, Raffaele Deluca, John Diaper, Loes Didden, Evanthia Dimitriou, Paulo do Nascimento Junior, Rudin Domi, Laurin Dorfinger, Luiz Fernando dos Reis Falcão, Christian Douradinho, Mojca Drnovšek Globokar, Ferdane Melike Duran, Abdelazeem Eldawlatly, Hala M. El-Gendy, Maram I. Elmazny, Salah-Eldin I. Elsherif, Moataz Maher Emara, Sharon Thali Enriquez de los Santos, Sarah Farnell-Ward, Renan Ferrufino, Marcelo Gama de Abreu, Lingling Gao, Dogu Geyik, Deja Gnezda, Steffie Goeden, Kristina Gorjup, Manuel Granell Gil, Ricardo Eli Guido Guerra, Maísa Guimarães de Castro Pereira, Pierre-Grégoire Guinot, Aysegul Guven, Helmut Hager, Ling Han, Zehra Hatipoglu, Megumi Hayashi, Johannes Hell, Jan Hofland, Markus W Hollmann, Jicheng Hu, Kamil Hudácek, Gentian Huti, Monika Ilic, Radmilo J Jankovic, Anita Jegarl, María-José Jiménez Andújar, Danfeng Jin, Tobias Kammerer, Vjekoslav Karadža, Izumi Kawagoe, Seher Irem Kiran Paudel, Thomas Kiss, Thea Koch, Nevenka Kolaric, Nick J. Koning, Kostas Kostopanagiotou, Andreas Kostroglou, Petra Kovac, Tim Kramer, Jens Kraßler, Tom Kreft, Yagmur Kumrular, Marieke Kuut, Lan Lan, Pei-Ching Li, Xue-Fei Li, Lan-Tao Li, Marc Licker, Yujia Liu, Ferdinando Longo, Torsten Loop, Manuel López-Baamonde, Stéphane Luise, Wenchen Luo, Hu Lv, Maria de los Angeles Macias Jimenez, Danielle Dourado Magalhães, Matteo Martuscelli, Ana Mavko, Basak Ceyda Meco, Hasan Alp Mermer, Changhong Miao, Pavel Michálek, Gary H. Mills, Encarna Miñana Aragón, Lucia Mirabella, Matthew Molyneux, Luigi Montrano, Loreto Mosqueira, Jo Mourisse, Matthew T. Murrell, Ricard Navarro-Ripoll, Florica Negru, Vojislava Neskovic, Mario Nikolic, Juana Abigail Norberto de la Vega, Alberto Noto, Vasileia Nyktari, Mukadder Orhan Sungur, Levent Ozdemir, Agnese Ozolina, Tulun Ozturk, Maria Caterina Pace, Eugenio Pagnussatt Neto, Balázs Pálóczi, Alexandra Papaioannou, Konstantinos Papamichail, Nicolò Patroniti, Yaser Pektas, Denis Pereira Matalobos, Jasminka Peršec, Stanislava Petrovic, Dejan Pirc, Gints Plismanis, Cristina Prata Amendola, Marko Pražetina, Nevena Radovic, Michela Rauseo, Torsten Richter, Lorena Rivera Vallejo, Juan José Rodriguez Ruiz, Goran Rondovic, Jon Rosser, Fernando J. Sánchez García, Pasquale Sansone, Ayten Saracoglu, Kemal Tolga Saracoglu, Hilal Sazak, Martin Scharffenberg, Lorenzo Schiavoni, Thomas Schilling, Aras. Sediq, Axel Semmelmann, Nüzhet Mert Sentürk, Emre Sertaç Bingül, Gokhan Sertcakacilar, Eleni Sfika, Benjamin Shelley, Sul Hwa Shin, Tatiana Sidiropoulou, João M Silva-Jr, Laura Socci, Tania Socorro, Eleftheria Soulioti, Savino Spadaro, Jasna Špicek-Macan, Dominic Spray, Dusica Stamenkovic, Georgios Stefanakis, Radu Stoica, Milena Stojanovic, Pascal Stopora, Zerrin Sungur, Elizabete Svareniece-Karjaka, Katalin Szamos, Narcis-Valentin Tanase, Cagin Tanriverdi, Franz Tempel, Lotte E. Terwindt, Raphael Theilen, Danijela Tipura, Yasin Tire, Eleonora Tomaselli, Neusa Tsuguie Onari, Mehtap Tunç, Özlem Turhan, Mediha Turktan, Daniele Ugliola, Halim Ulugöl, Tamás Végh, Luigi Vetrugno, Costanza Vitali, Carlo Alberto Volta, Vera von Dossow, Gregory Voyagis, Gregory Voyagis, Rade Vukovic, Anita Z Vukovic, Reiner M. Waeschle, David Wall, Hui Wang, Di Wang, Dag Winroth, Jakob Wittenstein, Qichao Wu, Peiyao Xu, Olcay Yaldir, Esra Yamansavci Sirzai, Xinlu Yang, Davud Yapici, Ozgucan Yildirim, Cigdem Yildirim Guclu, Hai Yu, Selvinaz Yuksel Tanriverdi, Alexander Zarbock, Snjezana Zeba, Yue Zhang, Xue Zhang, Zhenyu Zhang, Jinlin Zhang, Gong-Wei Zhang, Jing Zhong, Sebastian Ziemann","doi":"10.1016/s2213-2600(25)00330-3","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00330-3","url":null,"abstract":"<h3>Background</h3>The effect of higher positive end-expiratory pressure (PEEP) and recruitment manoeuvres aimed at lung expansion as compared with lower PEEP without recruitment manoeuvres aimed at permissive atelectasis on postoperative pulmonary complications (PPCs) in patients undergoing one-lung ventilation (OLV) during thoracic surgery is unclear. We aimed to determine the contribution of an intraoperative lung expansion strategy to preventing PPCs.<h3>Methods</h3>In this multicentre, randomised, controlled, international phase 3 trial (PROTHOR) conducted at 74 sites in 28 countries, we enrolled adult patients (aged ≥18 years) with a BMI of less than 35 kg/m<sup>2</sup> who were scheduled for open thoracic or video-assisted thoracoscopic surgery under general anaesthesia requiring one-lung ventilation with a double-lumen tube, with a planned operative time of more than 60 min, and an expected duration of one-lung ventilation longer than that of two-lung ventilation. Patients were randomly assigned (1:1), using permuted blocks of random size (4, 6, and 8) and stratified by study site, to receive one-lung ventilation with either a higher PEEP of 10 cm H<sub>2</sub>O and periodic lung recruitment manoeuvres (high PEEP group) or a lower PEEP of 5 cm H<sub>2</sub>O without routine recruitment manoeuvres (low PEEP group). All patients received protective tidal volumes of 5 mL/kg predicted body weight during one-lung ventilation and 7 mL/kg predicted body weight during two-lung ventilation. Postoperative assessors were masked to treatment allocation. The primary outcome was a composite of PPCs during the first 5 postoperative days, including aspiration pneumonia, moderate or severe respiratory failure, acute respiratory distress syndrome (ARDS), pulmonary infection, atelectasis, cardiopulmonary oedema, pleural effusion, non-operative pneumothorax, pulmonary infiltrates, prolonged air leak, purulent pleuritis, pulmonary embolism, and pulmonary haemorrhage. A modified intention-to-treat analysis was performed, with patients analysed according to their assigned treatment group, except in cases of withdrawal of informed consent, cancellation of surgery, and or loss to follow-up. This trial is registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span> (<span><span>NCT02963025</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>) and is completed.<h3>Findings</h3>Between Jan 3, 2017, and Feb 12, 2024, 2200 patients were randomly allocated: 1099 to the high PEEP group and 1101 to the low PEEP group. 43 patients in the high PEEP group and 33 in the low PEEP group were excluded from the modified intentio","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"95 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145492412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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