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Airway Driving Pressure Predicts Postoperative Pulmonary Complications Following Major Abdominal Surgery

2022; RELX Group (Netherlands); Linguagem: Inglês

10.2139/ssrn.4010882

1556-5068

Nicholas J. Douville, Timothy L. McMurry, Bhiken I. Naik, Michael R. Mathis, Douglas A. Colquhoun, Sachin Kheterpal, Nathan L. Pace, Randal S. Blank,

Cardiac Arrest and Resuscitation

Background: Airway driving pressure predicts adverse outcomes in critically ill patients, but large multicenter studies in major surgeries are lacking . We hypothesized that increased driving pressure is independently associated with postoperative pulmonary complications (PPCs) in patients undergoing major abdominal surgery.Methods: In this preregistered multicenter observational cohort study, the authors reviewed major abdominal surgeries across 10 hospitals from 2004 to 2018. The primary outcome was a composite of PPCs, defined as postoperative pneumonia, unplanned intubation, or prolonged ventilation greater than 48 hours . Associations between intraoperative dynamic driving pressure and outcomes, adjusted for patient and procedural factors, were evaluated. Secondary analyses assessed factors predictive of receiving high dynamic driving pressure ventilation.Findings: Among 14,341 cases reviewed, 394 (2.7%) experienced PPCs. After adjustment, mean dynamic driving pressure was associated with PPCs (adjusted odds ratio (aOR) for every 1 cmH 2 O increase: 1.03, 95% CI: 1.01-1.05, p=0.001). Neither tidal volume nor PEEP were associated with PPCs. Increased body mass index and shorter height were predictors for higher dynamic driving pressure (β: 0.36, 95% CI: 0.35-0.37, P<0.001; β: -0.01, 95% CI: -0.02-0.00, P=0.003, respectively). Shorter height was also independently predictive of PPCs (aOR: 0.98, 95% CI:0.97-0.99, P<0.001).Interpretation: The relationship between dynamic driving pressure and PPCs is consistent with our evolving understanding of the pathogenesis of PPCs. Our results may inform investigations of driving pressure-guided ventilation strategies for outcome improvement. Providers caring for short stature patients may need to exercise greater vigilance with regard to ventilation strategy, given the greater likelihood of exposure to high driving pressure and related adverse outcomes. Funding Information: This project was supported by departmental funding from University of Virginia and University of Michigan Anesthesiology departments. Dr. Nicholas Douville received support from a Foundation for Anesthesia Education and Research (FAER) - Mentored Research Training Grant (MRTG). Dr. Michael Mathis & Dr Douglas Colquhoun received grant funding support from the National Heart, Lung, and Blood Institute, Grants 1K01HL141701-03 (Mathis), 1K08HL159327-01(Colquhoun) Bethesda, MD for the proposed work. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. MPOG Funding Statement: Funding was also provided by departmental and institutional resources at each contributing MPOG site. In addition, partial funding to support underlying electronic health record data collection into the Multicenter Perioperative Outcomes Group registry was provided by Blue Cross Blue Shield of Michigan/Blue Care Network as part of the Blue Cross Blue Shield of Michigan/Blue Care Network Value Partnerships program. Although Blue Cross Blue Shield of Michigan/Blue Care Network and Multicenter Perioperative Outcomes Group work collaboratively, the opinions, beliefs and viewpoints expressed by the authors do not necessarily reflect the opinions, beliefs, and viewpoints of Blue Cross Blue Shield of Michigan/Blue Care Network or any of its employees. Declaration of Interests: The authors declare no competing interests beyond those described in the funding statement.Ethics Approval Statement: University of Virginia Institutional Review Board (21039) approval was obtained for this observational study. The Institutional Review Board of each contributing organization also approved aggregation of this limited dataset. Informed patient consent was waived because no patient care interventions were involved in the conduct of the study.