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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. | URI: | https://ahro.austin.org.au/austinjspui/handle/1/27436 | 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 |
Appears in Collections: | Journal articles |
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