Driving pressure-guided ventilation and postoperative pulmonary complications in thoracic surgery: a multicentre randomised clinical trial
DC Field | Value | Language |
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dc.contributor.author | Park, M. | - |
dc.contributor.author | Yoon, S. | - |
dc.contributor.author | Nam, J.-S. | - |
dc.contributor.author | Ahn, H.J. | - |
dc.contributor.author | Kim, H. | - |
dc.contributor.author | Kim, H.J. | - |
dc.contributor.author | Choi, H. | - |
dc.contributor.author | Kim, H.K. | - |
dc.contributor.author | Blank, R.S. | - |
dc.contributor.author | Yun, S.-C. | - |
dc.contributor.author | Lee, D.K. | - |
dc.contributor.author | Yang, M. | - |
dc.contributor.author | Kim, J.A. | - |
dc.contributor.author | Song, I. | - |
dc.contributor.author | Kim, B.R. | - |
dc.contributor.author | Bahk, J.-H. | - |
dc.contributor.author | Kim, J. | - |
dc.contributor.author | Lee, S. | - |
dc.contributor.author | Choi, I.-C. | - |
dc.contributor.author | Oh, Y.J. | - |
dc.contributor.author | Hwang, W. | - |
dc.contributor.author | Lim, B.G. | - |
dc.contributor.author | Heo, B.Y. | - |
dc.date.accessioned | 2022-11-19T21:40:51Z | - |
dc.date.available | 2022-11-19T21:40:51Z | - |
dc.date.created | 2022-11-18 | - |
dc.date.issued | 2022 | - |
dc.identifier.issn | 0007-0912 | - |
dc.identifier.uri | https://scholar.korea.ac.kr/handle/2021.sw.korea/146013 | - |
dc.description.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) | - |
dc.language | English | - |
dc.language.iso | en | - |
dc.publisher | Elsevier Ltd | - |
dc.title | Driving pressure-guided ventilation and postoperative pulmonary complications in thoracic surgery: a multicentre randomised clinical trial | - |
dc.type | Article | - |
dc.contributor.affiliatedAuthor | Kim, H.J. | - |
dc.identifier.doi | 10.1016/j.bja.2022.06.037 | - |
dc.identifier.scopusid | 2-s2.0-85136317129 | - |
dc.identifier.bibliographicCitation | British Journal of Anaesthesia | - |
dc.relation.isPartOf | British Journal of Anaesthesia | - |
dc.citation.title | British Journal of Anaesthesia | - |
dc.type.rims | ART | - |
dc.type.docType | Article in Press | - |
dc.description.journalClass | 1 | - |
dc.description.isOpenAccess | Y | - |
dc.description.journalRegisteredClass | scie | - |
dc.description.journalRegisteredClass | scopus | - |
dc.subject.keywordAuthor | airway driving pressure | - |
dc.subject.keywordAuthor | lung protective ventilation | - |
dc.subject.keywordAuthor | positive end-expiratory pressure | - |
dc.subject.keywordAuthor | postoperative pulmonary complications | - |
dc.subject.keywordAuthor | thoracic surgery | - |
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