Geo–economic variations in epidemiology, ventilation management and outcome of patients receiving intraoperative ventilation during general anesthesia– posthoc analysis of an observational study in 29 countries

BMC Anesthesiology

Hermann Wrigge¹  Marcos F. Vidal Melo²  Marcelo Gama de Abreu³  Christian Putensen⁴  Markus W. Hollmann⁵  Sabrine N. T. Hemmes⁵  Sunny G. L. H. Nijbroek⁶  Liselotte Hol⁶  Paolo Severgnini⁷  Ary Serpa Neto⁸  Marcus J. Schultz⁹  Goran Hedenstierna^1,10  Paolo Pelosi^1,11  Michael Hiesmayr^1,12  Werner Schmid^1,12  Gary H. Mills^1,13 

[1] Department of Anaesthesiology, Intensive Care Medicine and Emergency Medicine, Pain Therapy, Bermannstrost Hospital Halle, Halle, Germany;Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA;Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany;Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, OH, USA;Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA;Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany;Department of Anesthesiology, Amsterdam UMC, location AMC, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands;Department of Anesthesiology, Amsterdam UMC, location AMC, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands;Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands;Department of Biotechnology and Life, ASST Sette Laghi Ospedale di Circolo e Fondazio Macchi, University of Insubria, Varese, Italy;Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands;Department of Critical Care Medicine, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia;Department of Intensive Care, Amsterdam UMC, location AMC, 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;Department of Surgical Sciences and Integrated Diagnostics, Università degli Studi di Genova, Genova, Italy;Anesthesia and Critical Care, IRCCS for Oncology and Neurosciences, San Martino Policlinico Hospital, Genova, Italy;Division Cardiac, Thoracic, Vascular Anesthesia and Intensive Care, Medical University Vienna, Vienna, Austria;Operating Services, Critical Care and Anaesthesia, Sheffield Teaching Hospitals, Sheffield and University of Sheffield, Sheffield, UK;

关键词: Geo–economic variation;    Intraoperative ventilation;    ARISCAT score;    Postoperative pulmonary complications, ventilation, intraoperative ventilation;    Ventilator management;   

DOI  :  10.1186/s12871-021-01560-x

来源: Springer

【 摘 要 】

BackgroundThe aim of this analysis is to determine geo–economic variations in epidemiology, ventilator settings and outcome in patients receiving general anesthesia for surgery.MethodsPosthoc analysis of a worldwide study in 29 countries. Lower and upper middle–income countries (LMIC and UMIC), and high–income countries (HIC) were compared. The coprimary endpoint was the risk for and incidence of postoperative pulmonary complications (PPC); secondary endpoints were intraoperative ventilator settings, intraoperative complications, hospital stay and mortality.ResultsOf 9864 patients, 4% originated from LMIC, 11% from UMIC and 85% from HIC. The ARISCAT score was 17.5 [15.0–26.0] in LMIC, 16.0 [3.0–27.0] in UMIC and 15.0 [3.0–26.0] in HIC (P = .003). The incidence of PPC was 9.0% in LMIC, 3.2% in UMIC and 2.5% in HIC (P < .001). Median tidal volume in ml kg− 1 predicted bodyweight (PBW) was 8.6 [7.7–9.7] in LMIC, 8.4 [7.6–9.5] in UMIC and 8.1 [7.2–9.1] in HIC (P < .001). Median positive end–expiratory pressure in cmH2O was 3.3 [2.0–5.0]) in LMIC, 4.0 [3.0–5.0] in UMIC and 5.0 [3.0–5.0] in HIC (P < .001). Median driving pressure in cmH2O was 14.0 [11.5–18.0] in LMIC, 13.5 [11.0–16.0] in UMIC and 12.0 [10.0–15.0] in HIC (P < .001). Median fraction of inspired oxygen in % was 75 [50–80] in LMIC, 50 [50–63] in UMIC and 53 [45–70] in HIC (P < .001). Intraoperative complications occurred in 25.9% in LMIC, in 18.7% in UMIC and in 37.1% in HIC (P < .001). Hospital mortality was 0.0% in LMIC, 1.3% in UMIC and 0.6% in HIC (P = .009).ConclusionThe risk for and incidence of PPC is higher in LMIC than in UMIC and HIC. Ventilation management could be improved in LMIC and UMIC.Trial registrationClinicaltrials.gov, identifier: NCT01601223.

【 授权许可】

CC BY