Driving pressure-guided ventilation and postoperative pulmonary complications in thoracic surgery: a multicentre randomised clinical trialopen access
- Authors
- Park, M.; Yoon, S.; Nam, J.-S.; Ahn, H.J.; Kim, H.; Kim, H.J.; Choi, H.; Kim, H.K.; Blank, R.S.; Yun, S.-C.; Lee, D.K.; Yang, M.; Kim, J.A.; Song, I.; Kim, B.R.; Bahk, J.-H.; Kim, J.; Lee, S.; Choi, I.-C.; Oh, Y.J.; Hwang, W.; Lim, B.G.; Heo, B.Y.
- Issue Date
- 2022
- Publisher
- Elsevier Ltd
- Keywords
- airway driving pressure; lung protective ventilation; positive end-expiratory pressure; postoperative pulmonary complications; thoracic surgery
- Citation
- British Journal of Anaesthesia
- Indexed
- SCIE
SCOPUS
- Journal Title
- British Journal of Anaesthesia
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/146013
- DOI
- 10.1016/j.bja.2022.06.037
- ISSN
- 0007-0912
- 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)
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