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Title: Intraoperative open-lung condition and postoperative pulmonary complications. A secondary analysis of iPROVE and iPROVE-O2 trials.
Austin Authors: Ferrando, Carlos;Librero, Julian;Tusman, Gerardo;Serpa Neto, Ary ;Villar, Jesús;Belda, Francisco Javier;Costa, Eduardo;Amato, Marcelo Bp;Suarez-Sipmann, Fernando
Affiliation: Department of Intensive Care, Hospital Universitario La Princesa, Madrid, Spain
Department of Critical Care, Melbourne Medical Schoool, University of Melbourne, Austin Hospital, Melbourne, Australia
Cardio-Pulmonary Department, Pulmonary Division, Heart Institute (Incor), University of São Paulo, Sao Paulo, Brazil
Research and Education Institute, Hospital Sirio-Libanês, Sao Paulo, Brazil
Department of Surgical Sciences, Hedenstierna Laboratory, Uppsala University Hospital Uppsala, Sweden
Australian and New Zealand Intensive Care-Research Centre (ANZIC-RC), Monash University, Melbourne, Australia
Department of Critical Care Medicine. Hospital Israelita Albert Einstein, Sao Paulo, Brazil
Department of Anesthesiology and Critical Care, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, Spain
CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
Navarrabiomed, Complejo Hospitalario de Navarra, UPNA, REDISSEC (Red de Investigación en Servicios de Salud)
Department of Anesthesiology, Hospital Privado de Comunidad, Mar de Plata, Argentina
Department of Critical Care Medicine. Hospital Israelita Albert Einstein, Sao Paulo, Brazil
Cardio-Pulmonary Department, Pulmonary Division, Heart Institute (Incor), University of São Paulo, Sao Paulo, Brazil
Intensive Care
Issue Date: 30-Aug-2021
Date: 2021-08-30
Publication information: Acta Anaesthesiologica Scandinavica 2021; online first: 30 August
Abstract: The preventive role of an intraoperative recruitment manoeuvre plus open-lung approach (RM+OLA) ventilation on postoperative pulmonary complications (PPC) remains unclear. We aimed at investigating whether an intraoperative open-lung condition reduces the risk of developing a composite of PPCs. Post-hoc analysis of two randomised controlled trials including patients undergoing abdominal surgery. Patients were classified according to the intraoperative lung condition as "open" (OL) or "non-open" (NOL) if PaO2 /FIO2 ratio was ≥ or <400 mmHg, respectively. We used a multivariable logistic regression model that included potential confounders selected with directed acyclic graphs (DAG) using Dagitty software built with variables that were considered clinically relevant based on biological mechanism or evidence from previously published data. PPCs included severe acute respiratory failure, acute respiratory distress syndrome and pneumonia. A total of 1,480 patients were included in the final analysis, with 718 (49%) classified as OL. The rate of severe PPCs during the first 7 postoperative days was 6.0% (7.9% in the NOL and 4.4% in the OL group, p=0.007). OL was independently associated to a lower risk for severe PPCs during the first 7 and 30 postoperative days [odds ratio of 0.58 (95%CI 0.34-0.99, p=0.04 and 0.56 (95%CI 0.34-0.94, p=0.03), respectively]. An intraoperative open lung condition was associated to a reduced risk of developing severe PPCs in intermediate-to-high risk patients undergoing abdominal surgery.
DOI: 10.1111/aas.13979
ORCID: 0000-0002-1907-5323
Journal: Acta Anaesthesiologica Scandinavica
PubMed URL: 34460936
Type: Journal Article
Subjects: intraoperative
open lung
positive end-expiratory pressure
postoperative pulmonary complications
recruitment maneuvers
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