Associations of dynamic driving pressure and mechanical power with postoperative pulmonary complications-posthoc analysis of two randomised clinical trials in open abdominal surgery

Fecha de publicación: 01/05/2022 Fecha Ahead of Print: 16/04/2022

Autores de IIS La Fe

Guido Mazzinari

Autor

Participantes ajenos a IIS La Fe

Schuijt, Michiel T. U.
Hol, Liselotte
Nijbroek, Sunny G.
Ahuja, Sanchit
van Meenen, David
Hemmes, Sabrine
Bluth, Thomas
Ball, Lorenzo
Abreu, Marcelo Gama-de
Pelosi, Paolo
Schultz, Marcus J.
Neto, Ary Serpa
PROVHILO PROBESE Investigators

Grupos

Medicina Perioperatoria, Anestesiología y Reanimación

Leader

Óscar Díaz Cambronero

Abstract

BACKGROUND: While an association of the intraoperative driving pressure with postoperative pulmonary complications has been described before, it is uncertain whether the intraoperative mechanical power is associated with postoperative pulmonary complications. METHODS: Posthoc analysis of two international, multicentre randomised clinical trials (ISRCTN70332574 and NCT02148692) conducted between 2011-2013 and 2014-2018, in patients undergoing open abdominal surgery comparing the effect of two different positive end-expiratory pressure (PEEP) levels on postoperative pulmonary complications. Time-weighted average dynamic driving pressure and mechanical power were calculated for individual patients. A multivariable logistic regression model adjusted for confounders was used to assess the independent associations of driving pressure and mechanical power with the occurrence of a composite of postoperative pulmonary complications, the primary endpoint of this posthoc analysis. FINDINGS: In 1191 patients included, postoperative pulmonary complications occurrence was 35.9%. Median time-weighted average driving pressure and mechanical power were 14·0 [11·0-17·0] cmH(2)O, and 7·6 [5·1-10·0] J/min, respectively. While driving pressure was not independently associated with postoperative pulmonary complications (odds ratio, 1·06 [95% CI 0·88-1·28]; p=0.534), the mechanical power had an independent association with the occurrence of postoperative pulmonary complications (odds ratio, 1·28 [95% CI 1·05-1·57]; p=0.016). These findings were independent of body mass index or the level of PEEP used, i.e., independent of the randomisation arm. INTERPRETATION: In this merged cohort of surgery patients, higher intraoperative mechanical power was independently associated with postoperative pulmonary complications. Mechanical power could serve as a summary ventilatory biomarker for the risk for postoperative pulmonary complications in these patients, but our findings need confirmation in other, preferably prospective studies. FUNDING: The two original studies were supported by unrestricted grants from the European Society of Anaesthesiology and the Amsterdam University Medical Centers, Location AMC. For this current analysis, no additional funding was requested. The funding sources had neither a role in the design, collection of data, statistical analysis, interpretation of data, writing of the report, nor in the decision to submit the paper for publication.

Datos de la publicación

ISSN/ISSNe:: 2589-5370, 2589-5370
Tipo:: Article
Páginas:: 101397-101397
DOI:: 10.1016/j.eclinm.2022.101397
Factor de Impacto:: 4,657 SCImago ℠
Cuartil:: Q1 SCImago ℠

Documentos

No hay documentos

Métricas

Filiaciones

Schuijt, Michiel T. U.:: 1Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands., Amsterdam, Países Bajos.
Hol, Liselotte:: 1Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands., Amsterdam, Países Bajos.
Nijbroek, Sunny G.:: 1Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands., Amsterdam, Países Bajos.
Ahuja, Sanchit:: Henry Ford Hlth Syst, Dept Anaesthesiol Pain Management & Perioperat Me, Detroit, MI USA

Henry Ford Hlth Syst, Outcomes Res Consortium Cleveland Clin, Detroit, MI USA
van Meenen, David:: Amsterdam UMC, Locat AMC, Dept Intens Care, Amsterdam, Netherlands

Amsterdam UMC, Locat AMC, Dept Anaesthesiol, Amsterdam, Netherlands
Mazzinari, Guido:: 4Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain., Valencia, España.
Hemmes, Sabrine:: Henry Ford Hlth Syst, Dept Anaesthesiol Pain Management & Perioperat Me, Detroit, MI USA

Henry Ford Hlth Syst, Outcomes Res Consortium Cleveland Clin, Detroit, MI USA
Bluth, Thomas:: Tech Univ Dresden, Univ Hosp Carl Gustav Carus, Dept Anaesthesiol & Crit Care Med, Pulm Engn Grp, Dresden, Germany
Ball, Lorenzo:: Univ Genoa, Dept Surg Sci & Integrated Diagnost, Genoa, Italy

San Martino Policlin Hosp IRCCS Oncol & Neurosci, Dept Anaesthesia & Crit Care, Genoa, Italy
Abreu, Marcelo Gama-de:: Cleveland Clin, Dept Intens Care & Resuscitat, Cleveland, OH 44106 USA

Cleveland Clin, Dept Outcomes Res, Anaesthesiol Inst, Cleveland, OH 44106 USA
Pelosi, Paolo:: Univ Genoa, Dept Surg Sci & Integrated Diagnost, Genoa, Italy

San Martino Policlin Hosp IRCCS Oncol & Neurosci, Dept Anaesthesia & Crit Care, Genoa, Italy
Schultz, Marcus J.:: Amsterdam UMC, Locat AMC, Dept Intens Care, Amsterdam, Netherlands

Mahidol Univ, Mahidol Oxford Trop Med Res Unit MORU, Bangkok, Thailand

Univ Oxford, Nuffield Dept Med, Oxford, England

Hamilton Med AG, Dept Med Affairs, Bonaduz, Switzerland
Neto, Ary Serpa:: Amsterdam UMC, Locat AMC, Dept Intens Care, Amsterdam, Netherlands

Monash Univ, Australian & New Zealand Intens Care Res Ctr ANZI, Melbourne, Vic, Australia

Univ Melbourne, Austin Hosp, Melbourne Med Sch, Dept Crit Care, Melbourne, Vic, Australia

Hosp Israelita Albert Einstein, Dept Crit Care Med, Sao Paulo, Brazil

Univ Sao Paulo, Hosp Clin HCFMUSP, Fac Med, Cardiopulm Dept,Pulm Div,Inst Coracao, Sao Paulo, Brazil