Association of mechanical power and postoperative pulmonary complications among young children undergoing video-assisted thoracic surgery

Abstract

BACKGROUND Previous studies have discussed the correlation between mechanical power (MP) and lung injury. However, evidence regarding the relationship between MP and postoperative pulmonary complications (PPCs) in children remains limited, specifically during one-lung ventilation (OLV). OBJECTIVES Propensity score matching was employed to generate low MP and high MP groups to verify the relationship between MP and PPCs. Multivariable logistic regression was performed to identify risk factors of PPCs in young children undergoing video-assisted thoracic surgery (VATS). DESIGN A retrospective study. SETTING Single-site tertiary children's hospital. PATIENTS Children aged ≤2 years who underwent VATS between January 2018 and February 2023. INTERVENTIONS None. MAIN OUTCOME MEASURES The incidence of PPCs. RESULTS Overall, 581 (median age, 6 months [interquartile range: 5–9.24 months]) children were enrolled. The median [interquartile range] MP during OLV were 2.17 [1.84 to 2.64) J min−1. One hundred and nine (18.76%) children developed PPCs. MP decreased modestly during the study period (2.63 to 1.99 J min−1; P < 0.0001). In the propensity score matched cohort for MP (221 matched pairs), MP (median MP 2.63 vs. 1.84 J min−1) was not associated with a reduction in PPCs (adjusted odds ratio, 1.43; 95% CI, 0.87 to 2.37; P = 0.16). In the propensity score matched cohort for dynamic components of MP (139 matched pairs), dynamic components (mean 2.848 vs. 4.162 J min−1) was not associated with a reduction in PPCs (adjusted odds ratio, 1.62; 95% CI, 0.85 to 3.10; P = 0.15). The multiple logistic analysis revealed PPCs within 7 days of surgery were associated with male gender, OLV duration >90 min, less surgeon's experience and lower positive end-expiratory pressure (PEEP) value. CONCLUSIONS MP and dynamic components were not associated with PPCs in young children undergoing VATS, whereas PPCs were associated with male gender, OLV duration >90 min, lesser surgeon's experience and lower PEEP value. TRIAL REGISTRATION ChiCTR2300074649.