{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T13:40:42Z","timestamp":1783086042005,"version":"3.54.6"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T00:00:00Z","timestamp":1755734400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T00:00:00Z","timestamp":1755734400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100006920","name":"University of Pennsylvania","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006920","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["beva.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Equine Veterinary Journal"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Flow\u2010controlled expiration (FLEX) has been shown to significantly enhance oxygenation in horses under laboratory conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Prospective randomised clinical trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      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\u2010controlled ventilation) groups in dorsal (VCV\u2010D and FLEX\u2010D) or lateral recumbency (VCV\u2010L and FLEX\u2010L). Arterial blood gases were measured at 30, 75, and 120\u2009min post\u2010induction to assess arterial oxygenation (arterial partial pressure of oxygen to inspired fraction of oxygen ratio, PaO\n                      <jats:sub>2<\/jats:sub>\n                      \/FiO\n                      <jats:sub>2<\/jats:sub>\n                      ). A global index of ventilation\/perfusion matching ([PaCO\n                      <jats:sub>2<\/jats:sub>\n                      \u2009\u2212\u2009ETCO\n                      <jats:sub>2<\/jats:sub>\n                      ]\/PaCO\n                      <jats:sub>2<\/jats:sub>\n                      ) was also calculated. Peak airway pressure (P\n                      <jats:sub>peak<\/jats:sub>\n                      ) and tidal volume were measured to calculate dynamic respiratory system compliance (Cdyn). Data were compared with repeated\u2010measures ANOVA.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Horses ventilated with FLEX showed significantly higher PaO\n                      <jats:sub>2<\/jats:sub>\n                      \/FiO\n                      <jats:sub>2<\/jats:sub>\n                      (FLEX\u2010D vs. VCV\u2010D, 369\u2009\u00b1\u200942 vs. 198\u2009\u00b1\u2009112\u2009mmHg,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; FLEX\u2010L vs. VCV\u2010L, 436\u2009\u00b1\u200938 vs. 249\u2009\u00b1\u200988\u2009mmHg,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). FLEX also improved Cdyn (FLEX\u2010D vs. VCV\u2010D, 0.81\u2009\u00b1\u20090.1 vs. 0.64\u2009\u00b1\u20090.12,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01) and the global V\u0307\/Q\u0307 index ([PaCO\n                      <jats:sub>2<\/jats:sub>\n                      \u2009\u2212\u2009ETCO\n                      <jats:sub>2<\/jats:sub>\n                      ]\/PaCO\n                      <jats:sub>2<\/jats:sub>\n                      ) (FLEX\u2010D vs. VCV\u2010D, 0.11\u2009\u00b1\u20090.03 vs. 0.18\u2009\u00b1\u20090.03,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03) in dorsal\u2010positioned but not lateral\u2010positioned horses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Limitations<\/jats:title>\n                    <jats:p>Anaesthesia protocols were not standardised; anaesthetists were not masked to the intervention of interest, and findings may not be generalisable to other patient populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These results confirm previous laboratory findings, demonstrating that FLEX improves oxygenation, ventilation\u2013perfusion matching, and respiratory mechanics compared to VCV in a large clinical population of anaesthetised horses.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/evj.70079","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T03:05:32Z","timestamp":1755831932000},"page":"917-924","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Flow\u2010controlled expiration improves gas exchange in anaesthetised horses undergoing orthopaedic 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