Intra-operative ventilator mechanical power as a predictor of postoperative pulmonary complications in surgical patients: A secondary analysis of a randomised clinical trial.

2022-01-01

Karalapillai, Dharshi

Weinberg, Laurence

Neto, Ary Serpa

Peyton, Philip J

Ellard, Louise

Hu, Raymond T C

Pearce, Brett

Tan, Chong O

Story, David A

O'Donnell, Mark

Hamilton, Patrick

Oughton, Chad

Galtieri, Jonathan

Wilson, Anthony

Eastwood, Glenn M

Bellomo, Rinaldo

Jones, Daryl A

Journal Article

0000-0003-1520-9387

0000-0002-1650-8939

0000-0002-6446-3595

0000-0001-7403-7680

0000-0003-1185-2869

0000-0002-0169-0600

0000-0002-6479-1310

0000-0001-6195-3997

0000-0002-9173-9868

10.1097/EJA.0000000000001601

Studies in critically ill patients suggest a relationship between mechanical power (an index of the energy delivered by the ventilator, which includes driving pressure, respiratory rate, tidal volume and inspiratory pressure) and complications. We aimed to assess the association between intra-operative mechanical power and postoperative pulmonary complications (PPCs). Post hoc analysis of a large randomised clinical trial. University-affiliated academic tertiary hospital in Melbourne, Australia, from February 2015 to February 2019. Adult patients undergoing major noncardiothoracic, nonintracranial surgery. Dynamic mechanical power was calculated using the power equation adjusted by the respiratory system compliance (CRS). Multivariable models were used to assess the independent association between mechanical power and outcomes. The primary outcome was the incidence of PPCs within the first seven postoperative days. The secondary outcome was the incidence of acute respiratory failure. We studied 1156 patients (median age [IQR]: 64 [55 to 72] years, 59.5% men). Median mechanical power adjusted by CRS was 0.32 [0.22 to 0.51] (J min-1)/(ml cmH2O-1). A higher mechanical power was also independently associated with increased risk of PPCs [odds ratio (OR 1.34, 95% CI, 1.17 to 1.52); P < 0.001) and acute respiratory failure (OR 1.40, 95% CI, 1.21 to 1.61; P < 0.001). In patients receiving ventilation during major noncardiothoracic, nonintracranial surgery, exposure to a higher mechanical power was independently associated with an increased risk of PPCs and acute respiratory failure. Australia and New Zealand Clinical Trials Registry no: 12614000790640.

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European journal of anaesthesiology 2022; 39(1): 67-74

European journal of anaesthesiology