Driving pressure-guided ventilation and postoperative pulmonary complications in thoracic surgery: a multicentre randomised clinical trial

Park, MiHye; Yoon, Seo-Yeon; Nam, Jae‐Sik; Ahn, Hyun Joo; Kim, Heezoo; Kim, Hye Jin; Choi, Hoon; Kim, Hong Kwan; Blank, Randal S.; Yun, Sung‐Cheol; Lee, Dong Kyu; Yang, Mikyung; Kim, Jie Ae; Song, In-Sun; Kim, Bo Rim; Bahk, Jang-Jun; Kim, Juyoun; Lee, S.; Choi, In‐Cheol; Oh, Young Jun; Hwang, Wonjung; Lim, Byung Gun; Heo, Burn Young

doi:10.1016/j.bja.2022.06.037

Cited by 38 publications

(21 citation statements)

References 46 publications

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“…The driving pressure can be lowered up to 2.0 cmH 2 O using the alveolar recruitment maneuver and PEEP titration during surgery, thereby improving oxygenation and lung mechanics. [31][32][33] However, only a few prospective studies have investigated whether these physiological improvements can reduce PPC risk. [31][32][33] Further studies are warranted to clarify the effects of lowering driving pressure in liver transplant recipients who are at high risk of PPC.…”

Section: Discussionmentioning

confidence: 99%

“…[31][32][33] However, only a few prospective studies have investigated whether these physiological improvements can reduce PPC risk. [31][32][33] Further studies are warranted to clarify the effects of lowering driving pressure in liver transplant recipients who are at high risk of PPC.…”

Section: Discussionmentioning

confidence: 99%

“…The length of postoperative ICU and hospital stay were significantly longer in patients with PPCs than in those without PPCs (6 [5-7] d versus 5 [4][5][6] d, P < 0.001 and 27 d versus 24 [21][22][23][24][25][26][27][28][29][30][31][32][33][34] d, P = 0.005, respectively). As shown in Figure 1A, patient survival probability at 3, 6, and 12 mo after transplantation was 91.2% (87.5%-93.8%), 89.6% (85.7%-92.5%), and 86.5% (82.2%-89.8%), respectively, in patients with PPC and 98.3% (95.9%-99.3%), 96.5% (93.6%-98.1%), and 93.4% (89.8%-95.7%), respectively, in patients without PPC (HR 2.2 [1.3-3.6], P = 0.004).…”

Section: Association Between Ppc and Clinical Coursementioning

confidence: 99%

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Intraoperative Factors Modifying the Risk of Postoperative Pulmonary Complications After Living Donor Liver Transplantation

Kim

et al. 2023

Transplantation

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Background. The relationship between intraoperative anesthetic management and postoperative pulmonary complications (PPCs) after liver transplantation is not fully understood. We aimed to determine the intraoperative contributors to PPC. Methods. The retrospectively collected cohort included 605 patients who underwent living donor liver transplantation. PPCs comprised respiratory failure, respiratory infection, pulmonary edema, atelectasis (at least moderate degree), pneumothorax, and pleural effusion (at least moderate degree). The presence and type of PPC were evaluated by 2 pulmonary physicians. Logistic regression analysis was performed to determine the association between perioperative variables and PPC risk. Results. Of the 605 patients, 318 patients (52.6%) developed 486 PPCs. Multivariable analysis demonstrated that PPC risk decreased with low tidal volume ventilation (odds ratio [OR] 0.62 [0.41-0.94], P = 0.023) and increased with greater driving pressure at the end of surgery (OR 1.08 [1.01-1.14], P = 0.018), prolonged hypotension (OR 1.85 [1.27-2.70], P = 0.001), and blood albumin level ≤3.0 g/dL at the end of surgery (OR 2.43 [1.51-3.92], P < 0.001). Survival probability at 3, 6, and 12 mo after transplantation was 91.2%, 89.6%, and 86.5%, respectively, in patients with PPCs and 98.3%, 96.5%, and 93.4%, respectively, in patients without PPCs (hazard ratio 2.2 [1.3-3.6], P = 0.004). Graft survival probability at 3, 6, and 12 mo after transplantation was 89.3%, 87.1%, and 84.3%, respectively, in patients with PPCs and 97.6%, 95.8%, and 92.7%, respectively, in patients without PPCs (hazard ratio 2.3 [1.4-3.7], P = 0.001). Conclusions. We found that tidal volume, driving pressure, hypotension, and albumin level during living donor liver transplantation were significantly associated with PPC risk. These data may help determine patients at risk of PPC or develop an intraoperative lung-protective strategy for liver transplant recipients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Association Between Ppc and Clinical Coursementioning

confidence: 99%

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Intraoperative Factors Modifying the Risk of Postoperative Pulmonary Complications After Living Donor Liver Transplantation

Kim

et al. 2023

Transplantation

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“…During one-lung ventilation, partial pressure of oxygen may decrease and peak airway pressure may increase. The application of PEEP levels of less than or equal to 5 cmH 2 O can improve oxygenation and to correct hypoxemia, 20,30 while avoiding high airway pressure and lung injury caused by excessive alveolar expansion, 31 thereby reducing the incidence of postoperative pulmonary PPCs " 46, 109,118,119 Stable hemodynamic " 108,132,138 CRS " 108,115,118,119,127,132,138 Individual PEEP calculated by imaging method Oxygenation " 151,152,160 Beneficial 143,158 PPCs " 142,144,153 Stable hemodynamic " 160 Abbreviations: CRS, respiratory system compliance; PEEP, positive end-expiratory pressure; PPCs, postoperative pulmonary complications; SrO 2 , cerebral oxygen saturation; ", represents activation; #, represents inhibition.…”

Section: Clinical Researchmentioning

confidence: 99%

“… 125 , 126 While in a large multicenter randomized trial, PEEP guided by driving pressure did not reduce the incidence of PPCs though improving intraoperative lung compliance and arterial partial pressure of oxygen during pneumonectomy compared with 5 cmH 2 O PEEP. 127 Wang F et al believed that PEEP guided by driving pressure could effectively alleviate postoperative inflammatory response because the results showed the level of postoperative inflammatory factors of IL‐6 and HMGB1 were decreased, which may be related to its reducing the number of collapsed alveoli and maintaining the expansion of distal collapsed airway. 128 The evidence supporting the driving pressure method to titrate individualized PEEP is limited.…”

Section: Explore the Optimal Individualized Peep Valuementioning

confidence: 99%

A structured narrative review of clinical and experimental studies of the use of different positive end‐expiratory pressure levels during thoracic surgery

Yueyi

Tan

2022

Clinical Respiratory J

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Objectives This study aimed to present a review on the general effects of different positive end‐expiratory pressure (PEEP) levels during thoracic surgery by qualitatively categorizing the effects into detrimental, beneficial, and inconclusive. Data source Literature search of Pubmed, CNKI, and Wanfang was made to find relative articles about PEEP levels during thoracic surgery. We used the following keywords as one‐lung ventilation, PEEP, and thoracic surgery. Results We divide the non‐individualized PEEP value into five grades, that is, less than 5, 5, 5–10, 10, and more than 10 cmH2O, among which 5 cmH2O is the most commonly used in clinic at present to maintain alveolar dilatation and reduce the shunt fraction and the occurrence of atelectasis, whereas individualized PEEP, adjusted by test titration or imaging method to adapt to patients' personal characteristics, can effectively ameliorate intraoperative oxygenation and obtain optimal pulmonary compliance and better indexes relating to respiratory mechanics. Conclusions Available data suggest that PEEP might play an important role in one‐lung ventilation, the understanding of which will help in exploring a simple and economical method to set the appropriate PEEP level.

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Fokus Beatmung, Sauerstofftherapie und Weaning 2022–2024

Fiedler-Kalenka,

Brenner,

Bernhard

et al. 2024

Anaesthesiologie

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Driving pressure-guided ventilation and postoperative pulmonary complications in thoracic surgery: a multicentre randomised clinical trial

Cited by 38 publications

References 46 publications

Intraoperative Factors Modifying the Risk of Postoperative Pulmonary Complications After Living Donor Liver Transplantation

Intraoperative Factors Modifying the Risk of Postoperative Pulmonary Complications After Living Donor Liver Transplantation

A structured narrative review of clinical and experimental studies of the use of different positive end‐expiratory pressure levels during thoracic surgery

Fokus Beatmung, Sauerstofftherapie und Weaning 2022–2024

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