Driving pressure-guided ventilation and postoperative pulmonary complications in thoracic surgery: a multicentre randomised clinical trialopen access
- Authors
- Park, M.[Park, M.]; Yoon, S.[Yoon, S.]; Nam, J.-S.[Nam, J.-S.]; Ahn, H.J.[Ahn, H.J.]; Kim, H.[Kim, H.]; Kim, H.J.[Kim, H.J.]; Choi, H.[Choi, H.]; Kim, H.K.[Kim, H.K.]; Blank, R.S.[Blank, R.S.]; Yun, S.-C.[Yun, S.-C.]; Lee, D.K.[Lee, D.K.]; Yang, M.[Yang, M.]; Kim, J.A.[Kim, J.A.]; Song, I.[Song, I.]; Kim, B.R.[Kim, B.R.]; Bahk, J.-H.[Bahk, J.-H.]; Kim, J.[Kim, J.]; Lee, S.[Lee, S.]; Choi, I.-C.[Choi, I.-C.]; Oh, Y.J.[Oh, Y.J.]; Hwang, W.[Hwang, W.]; Lim, B.G.[Lim, B.G.]; Heo, B.Y.[Heo, B.Y.]
- Issue Date
- Jan-2022
- Publisher
- Elsevier Ltd
- Keywords
- airway driving pressure; lung protective ventilation; positive end-expiratory pressure; postoperative pulmonary complications; thoracic surgery
- Citation
- British Journal of Anaesthesia, v.130, no.1, pp.E106 - E118
- Indexed
- SCIE
SCOPUS
- Journal Title
- British Journal of Anaesthesia
- Volume
- 130
- Number
- 1
- Start Page
- E106
- End Page
- E118
- URI
- https://scholarworks.bwise.kr/skku/handle/2021.sw.skku/100518
- DOI
- 10.1016/j.bja.2022.06.037
- ISSN
- 0007-0912
- Abstract
- Background: Airway driving pressure, easily measured as plateau pressure minus PEEP, is a surrogate for alveolar stress and strain. However, the effect of its targeted reduction remains unclear. Methods: In this multicentre trial, patients undergoing lung resection surgery were randomised to either a driving pressure group (n=650) receiving an alveolar recruitment/individualised PEEP to deliver the lowest driving pressure or to a conventional protective ventilation group (n=650) with fixed PEEP of 5 cm H2O. The primary outcome was a composite of pulmonary complications within 7 days postoperatively. Results: The modified intention-to-treat analysis included 1170 patients (mean [standard deviation, SD]; age, 63 [10] yr; 47% female). The mean driving pressure was 7.1 cm H2O in the driving pressure group vs 9.2 cm H2O in the protective ventilation group (mean difference [95% confidence interval, CI]; −2.1 [−2.4 to −1.9] cm H2O; P<0.001). The incidence of pulmonary complications was not different between the two groups: driving pressure group (233/576, 40.5%) vs protective ventilation group (254/594, 42.8%) (risk difference −2.3%; 95% CI, −8.0% to 3.3%; P=0.42). Intraoperatively, lung compliance (mean [SD], 42.7 [12.4] vs 33.5 [11.1] ml cm H2O−1; P<0.001) and Pao2 (median [inter-quartile range], 21.5 [14.5 to 30.4] vs 19.5 [13.5 to 29.1] kPa; P=0.03) were higher and the need for rescue ventilation was less frequent (6.8% vs 10.8%; P=0.02) in the driving pressure group. Conclusions: In lung resection surgery, a driving pressure-guided ventilation improved pulmonary mechanics intraoperatively, but did not reduce the incidence of postoperative pulmonary complications compared with a conventional protective ventilation. Clinical trial registration: NCT04260451. © 2022 The Author(s)
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