Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/30042
Title: Associations of dynamic driving pressure and mechanical power with postoperative pulmonary complications-posthoc analysis of two randomised clinical trials in open abdominal surgery.
Austin Authors: Schuijt, Michiel T U;Hol, Liselotte;Nijbroek, Sunny G;Ahuja, Sanchit;van Meenen, David;Mazzinari, Guido;Hemmes, Sabrine;Bluth, Thomas;Ball, Lorenzo;Gama-de Abreu, Marcelo;Pelosi, Paolo;Schultz, Marcus J;Serpa Neto, Ary 
Affiliation: Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands..
Department of Anaesthesiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands..
Department of Anaesthesiology, Pain Management & Perioperative Medicine, & Outcomes Research Consortium Cleveland Clinic, Henry Ford Health System, Detroit, Michigan, The United States of America..
Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain..
Department of Anaesthesiology and Critical Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany..
Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy..
Department of Anaesthesia and Critical Care, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy..
Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, Ohio, The United States of America..
Department of Outcomes Research, Anaesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, The United States of America..
Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand..
Nuffield Department of Medicine, University of Oxford, Oxford, The United Kingdom..
Department of Medical Affairs, Hamilton Medical AG, Bonaduz, Switzerland..
Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia..
Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia..
Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil..
Cardio-Pulmonary Department, Pulmonary Division, Faculdade de Medicina, Instituto do Coração, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil..
Issue Date: 16-Apr-2022
Date: 2022-05
Publication information: EClinicalMedicine 2022; 47: 101397
Abstract: While an association of the intraoperative driving pressure with postoperative pulmonary complications has been described before, it is uncertain whether the intraoperative mechanical power is associated with postoperative pulmonary complications. Posthoc analysis of two international, multicentre randomised clinical trials (ISRCTN70332574 and NCT02148692) conducted between 2011-2013 and 2014-2018, in patients undergoing open abdominal surgery comparing the effect of two different positive end-expiratory pressure (PEEP) levels on postoperative pulmonary complications. Time-weighted average dynamic driving pressure and mechanical power were calculated for individual patients. A multivariable logistic regression model adjusted for confounders was used to assess the independent associations of driving pressure and mechanical power with the occurrence of a composite of postoperative pulmonary complications, the primary endpoint of this posthoc analysis. In 1191 patients included, postoperative pulmonary complications occurrence was 35.9%. Median time-weighted average driving pressure and mechanical power were 14·0 [11·0-17·0] cmH2O, and 7·6 [5·1-10·0] J/min, respectively. While driving pressure was not independently associated with postoperative pulmonary complications (odds ratio, 1·06 [95% CI 0·88-1·28]; p=0.534), the mechanical power had an independent association with the occurrence of postoperative pulmonary complications (odds ratio, 1·28 [95% CI 1·05-1·57]; p=0.016). These findings were independent of body mass index or the level of PEEP used, i.e., independent of the randomisation arm. In this merged cohort of surgery patients, higher intraoperative mechanical power was independently associated with postoperative pulmonary complications. Mechanical power could serve as a summary ventilatory biomarker for the risk for postoperative pulmonary complications in these patients, but our findings need confirmation in other, preferably prospective studies. The two original studies were supported by unrestricted grants from the European Society of Anaesthesiology and the Amsterdam University Medical Centers, Location AMC. For this current analysis, no additional funding was requested. The funding sources had neither a role in the design, collection of data, statistical analysis, interpretation of data, writing of the report, nor in the decision to submit the paper for publication.
URI: https://ahro.austin.org.au/austinjspui/handle/1/30042
DOI: 10.1016/j.eclinm.2022.101397
ORCID: 0000-0003-1520-9387
Journal: EClinicalMedicine
PubMed URL: 35480074
PubMed URL: https://pubmed.ncbi.nlm.nih.gov/35480074/
Type: Journal Article
Subjects: Driving pressure
Intensity of ventilation
Intraoperative
Mechanical power
Mechanical ventilation
Postoperative pulmonary complication
Appears in Collections:Journal articles

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