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Airway driving pressure is associated with postoperative pulmonary complications after major abdominal surgery: a multicentre retrospective observational cohort study

BACKGROUND: High airway driving pressure is associated with adverse outcomes in critically ill patients receiving mechanical ventilation, but large multicentre studies investigating airway driving pressure during major surgery are lacking. We hypothesised that increased driving pressure is associate...

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Autores principales: Douville, Nicholas J., McMurry, Timothy L., Ma, Jennie Z., Naik, Bhiken I., Mathis, Michael R., Colquhoun, DouglasA., Kheterpal, Sachin, Pace, Nathan L., Hedrick, Traci L., Blank, Randal S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9853922/
https://www.ncbi.nlm.nih.gov/pubmed/36687665
http://dx.doi.org/10.1016/j.bjao.2022.100099
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author Douville, Nicholas J.
McMurry, Timothy L.
Ma, Jennie Z.
Naik, Bhiken I.
Mathis, Michael R.
Colquhoun, DouglasA.
Kheterpal, Sachin
Pace, Nathan L.
Hedrick, Traci L.
Blank, Randal S.
author_facet Douville, Nicholas J.
McMurry, Timothy L.
Ma, Jennie Z.
Naik, Bhiken I.
Mathis, Michael R.
Colquhoun, DouglasA.
Kheterpal, Sachin
Pace, Nathan L.
Hedrick, Traci L.
Blank, Randal S.
author_sort Douville, Nicholas J.
collection PubMed
description BACKGROUND: High airway driving pressure is associated with adverse outcomes in critically ill patients receiving mechanical ventilation, but large multicentre studies investigating airway driving pressure during major surgery are lacking. We hypothesised that increased driving pressure is associated with postoperative pulmonary complications in patients undergoing major abdominal surgery. METHODS: In this preregistered multicentre retrospective observational cohort study, the authors reviewed major abdominal surgical procedures in 11 hospitals from 2004 to 2018. The primary outcome was a composite of postoperative pulmonary complications, defined as postoperative pneumonia, unplanned tracheal intubation, or prolonged mechanical ventilation for more than 48 h. Associations between intraoperative dynamic driving pressure and outcomes, adjusted for patient and procedural factors, were evaluated. RESULTS: Among 14 218 qualifying cases, 389 (2.7%) experienced postoperative pulmonary complications. After adjustment, the mean dynamic driving pressure was associated with postoperative pulmonary complications (adjusted odds ratio for every 1 cm H(2)O increase: 1.04; 95% confidence interval [CI], 1.02–1.06; P<0.001). Neither tidal volume nor PEEP was associated with postoperative pulmonary complications. Increased BMI, shorter height, and female sex were predictors for higher dynamic driving pressure (β=0.35, 95% CI 0.32–0.39, P<0.001; β=–0.01, 95% CI –0.02 to 0.00, P=0.005; and β=0.74, 95% CI 0.63–0.86, P<0.001, respectively). CONCLUSIONS: Dynamic airway driving pressure, but not tidal volume or PEEP, is associated with postoperative pulmonary complications in models controlling for a large number of risk predictors and covariates. Such models are capable of risk prediction applicable to individual patients.
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spelling pubmed-98539222023-01-20 Airway driving pressure is associated with postoperative pulmonary complications after major abdominal surgery: a multicentre retrospective observational cohort study Douville, Nicholas J. McMurry, Timothy L. Ma, Jennie Z. Naik, Bhiken I. Mathis, Michael R. Colquhoun, DouglasA. Kheterpal, Sachin Pace, Nathan L. Hedrick, Traci L. Blank, Randal S. BJA Open Original Research Article BACKGROUND: High airway driving pressure is associated with adverse outcomes in critically ill patients receiving mechanical ventilation, but large multicentre studies investigating airway driving pressure during major surgery are lacking. We hypothesised that increased driving pressure is associated with postoperative pulmonary complications in patients undergoing major abdominal surgery. METHODS: In this preregistered multicentre retrospective observational cohort study, the authors reviewed major abdominal surgical procedures in 11 hospitals from 2004 to 2018. The primary outcome was a composite of postoperative pulmonary complications, defined as postoperative pneumonia, unplanned tracheal intubation, or prolonged mechanical ventilation for more than 48 h. Associations between intraoperative dynamic driving pressure and outcomes, adjusted for patient and procedural factors, were evaluated. RESULTS: Among 14 218 qualifying cases, 389 (2.7%) experienced postoperative pulmonary complications. After adjustment, the mean dynamic driving pressure was associated with postoperative pulmonary complications (adjusted odds ratio for every 1 cm H(2)O increase: 1.04; 95% confidence interval [CI], 1.02–1.06; P<0.001). Neither tidal volume nor PEEP was associated with postoperative pulmonary complications. Increased BMI, shorter height, and female sex were predictors for higher dynamic driving pressure (β=0.35, 95% CI 0.32–0.39, P<0.001; β=–0.01, 95% CI –0.02 to 0.00, P=0.005; and β=0.74, 95% CI 0.63–0.86, P<0.001, respectively). CONCLUSIONS: Dynamic airway driving pressure, but not tidal volume or PEEP, is associated with postoperative pulmonary complications in models controlling for a large number of risk predictors and covariates. Such models are capable of risk prediction applicable to individual patients. Elsevier 2022-10-18 /pmc/articles/PMC9853922/ /pubmed/36687665 http://dx.doi.org/10.1016/j.bjao.2022.100099 Text en © 2022 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research Article
Douville, Nicholas J.
McMurry, Timothy L.
Ma, Jennie Z.
Naik, Bhiken I.
Mathis, Michael R.
Colquhoun, DouglasA.
Kheterpal, Sachin
Pace, Nathan L.
Hedrick, Traci L.
Blank, Randal S.
Airway driving pressure is associated with postoperative pulmonary complications after major abdominal surgery: a multicentre retrospective observational cohort study
title Airway driving pressure is associated with postoperative pulmonary complications after major abdominal surgery: a multicentre retrospective observational cohort study
title_full Airway driving pressure is associated with postoperative pulmonary complications after major abdominal surgery: a multicentre retrospective observational cohort study
title_fullStr Airway driving pressure is associated with postoperative pulmonary complications after major abdominal surgery: a multicentre retrospective observational cohort study
title_full_unstemmed Airway driving pressure is associated with postoperative pulmonary complications after major abdominal surgery: a multicentre retrospective observational cohort study
title_short Airway driving pressure is associated with postoperative pulmonary complications after major abdominal surgery: a multicentre retrospective observational cohort study
title_sort airway driving pressure is associated with postoperative pulmonary complications after major abdominal surgery: a multicentre retrospective observational cohort study
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9853922/
https://www.ncbi.nlm.nih.gov/pubmed/36687665
http://dx.doi.org/10.1016/j.bjao.2022.100099
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