The Association of Intraoperative driving pressure with postoperative pulmonary complications in open versus closed abdominal surgery patients – a posthoc propensity score–weighted cohort analysis of the LAS VEGAS study

BMC Anesthesiology

Marcos F. Vidal Melo¹  Christian Putensen²  Marcelo Gama de Abreu³  Hermann Wrigge⁴  Paolo Severgnini⁵  Ary Serpa Neto⁶  Markus W. Hollmann⁷  Sabrine N. T. Hemmes⁷  Marcus J. Schultz⁸  Goran Hedenstierna⁹  Michael Hiesmayr^1,10  Werner Schmid^1,10  Gary H. Mills^1,11  Samir Jaber^1,12  Paolo Pelosi^1,13  Lorenzo Ball^1,13  Rupert M. Pearse^1,14  Guido Mazzinari^1,15  Oscar Diaz Cambronero^1,15 

[1] Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, USA;Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany;Department of Anesthesiology and Intensive Care Therapy, Pulmonary Engineering Group, Technische Universität Dresden, Dresden, Germany;Department of Anesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital, Halle, Germany;Department of Biotechnology and Sciences of Life, ASST- Settelaghi Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy;Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil;Cardio-Pulmonary Department, Pulmonary Division, Faculdade de Medicina, Instituto do Coração, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil;Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Academic Medical Center, Amsterdam, The Netherlands;Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Academic Medical Center, Amsterdam, The Netherlands;Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Academic Medical Center, Amsterdam, The Netherlands;Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand;Nuffield Department of Medicine, University of Oxford, Oxford, UK;Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden;Division Cardiac, Thoracic, Vascular Anesthesia and Intensive Care, Medical University Vienna, Vienna, Austria;Operating Services, Critical Care and Anesthesia, Sheffield Teaching Hospitals, Sheffield and University of Sheffield, Sheffield, UK;PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, Montpellier, France;Policlinico San Martino Hospital – IRCCS for Oncology and Neurosciences, Genoa, Italy;Department of Surgical Sciences and Integrated Diagnostics, University of Genoa Italy, Genoa, Italy;Queen Mary University of London, London, UK;Research Group in Perioperative Medicine, Hospital Universitario y Politécnico la Fe, Avinguda de Fernando Abril Martorell 106, 46026, Valencia, Spain;Department of Anesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain;

关键词: Pneumoperitoneum;    Laparoscopy;    Laparoscopic surgery;    Perioperative ventilation;    Protective ventilation;    PEEP;    Respiratory mechanics;    Driving pressure;   

DOI  :  10.1186/s12871-021-01268-y

来源: Springer

【 摘 要 】

BackgroundIt is uncertain whether the association of the intraoperative driving pressure (ΔP) with postoperative pulmonary complications (PPCs) depends on the surgical approach during abdominal surgery. Our primary objective was to determine and compare the association of time–weighted average ΔP (ΔPTW) with PPCs. We also tested the association of ΔPTW with intraoperative adverse events.MethodsPosthoc retrospective propensity score–weighted cohort analysis of patients undergoing open or closed abdominal surgery in the ‘Local ASsessment of Ventilatory management during General Anaesthesia for Surgery’ (LAS VEGAS) study, that included patients in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs. The secondary endpoint was a composite of intraoperative adverse events.ResultsThe analysis included 1128 and 906 patients undergoing open or closed abdominal surgery, respectively. The PPC rate was 5%. ΔP was lower in open abdominal surgery patients, but ΔPTW was not different between groups. The association of ΔPTW with PPCs was significant in both groups and had a higher risk ratio in closed compared to open abdominal surgery patients (1.11 [95%CI 1.10 to 1.20], P <  0.001 versus 1.05 [95%CI 1.05 to 1.05], P <  0.001; risk difference 0.05 [95%CI 0.04 to 0.06], P <  0.001). The association of ΔPTW with intraoperative adverse events was also significant in both groups but had higher odds ratio in closed compared to open abdominal surgery patients (1.13 [95%CI 1.12– to 1.14], P <  0.001 versus 1.07 [95%CI 1.05 to 1.10], P <  0.001; risk difference 0.05 [95%CI 0.030.07], P <  0.001).ConclusionsΔP is associated with PPC and intraoperative adverse events in abdominal surgery, both in open and closed abdominal surgery.Trial registrationLAS VEGAS was registered at clinicaltrials.gov (trial identifier NCT01601223).

【 授权许可】

CC BY