Association between intraoperative tidal volume and postoperative respiratory complications is dependent on respiratory elastance: a retrospective, multicentre cohort study

Suleiman, Aiman; Costa, Eduardo L. V.; Santer, Peter; Tartler, Tim M.; Wachtendorf, Luca J.; Teja, Bijan; Chen, Guanqing; Baedorf‐Kassis, Elias N.; Nagrebetsky, Alexander; Melo, Marcos F. Vidal; Eikermann, Matthias; Schaefer, Maximilian S.

doi:10.1016/j.bja.2022.05.005

Cited by 16 publications

(17 citation statements)

References 47 publications

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“…Recent data from our group suggest that mechanical power is modifiable with changes in tidal volumes and respiratory rate resulting in changes in resulting power with variable impact based upon lung mechanics [ 25 , 52 ]. This compliance matching, while not directly proving causality or that power is modifiable, suggests that power is more than a simple marker for disease severity and that the association between 30-day mortality and mechanical power is not influenced by COVID-19, regardless of the patient's respiratory system compliance.…”

Section: Discussionmentioning

confidence: 99%

Mechanical power and 30-day mortality in mechanically ventilated, critically ill patients with and without Coronavirus Disease-2019: a hospital registry study

et al. 2023

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Background Previous studies linked a high intensity of ventilation, measured as mechanical power, to mortality in patients suffering from “classic” ARDS. By contrast, mechanically ventilated patients with a diagnosis of COVID-19 may present with intact pulmonary mechanics while undergoing mechanical ventilation for longer periods of time. We investigated whether an association between higher mechanical power and mortality is modified by a diagnosis of COVID-19. Methods This retrospective study included critically ill, adult patients who were mechanically ventilated for at least 24 h between March 2020 and December 2021 at a tertiary healthcare facility in Boston, Massachusetts. The primary exposure was median mechanical power during the first 24 h of mechanical ventilation, calculated using a previously validated formula. The primary outcome was 30-day mortality. As co-primary analysis, we investigated whether a diagnosis of COVID-19 modified the primary association. We further investigated the association between mechanical power and days being alive and ventilator free and effect modification of this by a diagnosis of COVID-19. Multivariable logistic regression, effect modification and negative binomial regression analyses adjusted for baseline patient characteristics, severity of disease and in-hospital factors, were applied. Results 1,737 mechanically ventilated patients were included, 411 (23.7%) suffered from COVID-19. 509 (29.3%) died within 30 days. The median mechanical power during the first 24 h of ventilation was 19.3 [14.6–24.0] J/min in patients with and 13.2 [10.2–18.0] J/min in patients without COVID-19. A higher mechanical power was associated with 30-day mortality (ORadj 1.26 per 1-SD, 7.1J/min increase; 95% CI 1.09–1.46; p = 0.002). Effect modification and interaction analysis did not support that this association was modified by a diagnosis of COVID-19 (95% CI, 0.81–1.38; p-for-interaction = 0.68). A higher mechanical power was associated with a lower number of days alive and ventilator free until day 28 (IRRadj 0.83 per 7.1 J/min increase; 95% CI 0.75–0.91; p < 0.001, adjusted risk difference − 2.7 days per 7.1J/min increase; 95% CI − 4.1 to − 1.3). Conclusion A higher mechanical power is associated with elevated 30-day mortality. While patients with COVID-19 received mechanical ventilation with higher mechanical power, this association was independent of a concomitant diagnosis of COVID-19.

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Section: Discussionmentioning

confidence: 99%

Mechanical power and 30-day mortality in mechanically ventilated, critically ill patients with and without Coronavirus Disease-2019: a hospital registry study

et al. 2023

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“…PPCs encompass a series of respiratory diseases, ranging from asymptomatic atelectasis to respiratory failure,1 31 which are challenging to perioperative management for patients undergoing major surgery and relevant to prolonged hospital stays and elevated mortality 32. The incidence of PPCs is multifactorial, varied considerably, and is usually dependent on surgical factors and individual characteristics.…”

Section: Discussionmentioning

confidence: 99%

Association of preoperative spirometry tests with postoperative pulmonary complications after mediastinal mass resection: protocol for a retrospective cohort study

Zhang

et al. 2023

BMJ Open

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IntroductionPatients with a mediastinal mass are at risk of pulmonary complications in the perioperative period. Preoperative spirometry tests are recommended in patients scheduled for thoracic surgery. Our objective is to investigate the association between preoperative spirometry results and the incidence of postoperative pulmonary complications in patients following mediastinal mass resection, which may determine the usefulness of spirometry tests in the prediction of the perioperative respiratory risk.Methods and analysisThis protocol describes a retrospective cohort study of patients with mediastinal masses in Shanghai Pulmonary Hospital between 1 September 2021 and 1 September 2022, with a planned sample size of 660 patients. The primary aim of this study is to explore the association between preoperative spirometry results and the occurrence of postoperative pulmonary complications after mediastinal mass resection. Logistic regression analysis will be used to calculate the adjusted incidence rate difference and incidence rate ratios (with 95% CIs).Ethics and disseminationThe study was approved by the ethics committee of Shanghai Pulmonary Hospital (K21-372Y). The results of the study will be submitted to a peer-reviewed biomedical journal for publication and presented at relevant conferences.

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“…Our group recently corroborated these findings in a cohort of 197,474 surgical patients where higher intraoperative tidal volumes (greater than 8 ml/kg) were associated with increased risk of postoperative respiratory failure only in patients with a low compliance, and this effect was completely mediated by the resulting driving pressure. 5 In addition to lowering the applied tidal volume, modification of PEEP, which was the second factor in the trial by Turan et al , 1 can reduce driving pressure through shifting tidal ventilation toward the high-compliance part of the pressure or volume loop. However, even in patients with “healthy” lungs undergoing general anesthesia, PEEP requirements are heterogeneous, and a “standard” PEEP is often inadequate.…”

Section: To the Editormentioning

confidence: 99%

“…6,7 To better understand the effect of the study intervention, it would be helpful if the driving pressure per group could be provided by Turan et al to understand group differentiation regarding this crucial factor. Based on previous literature, 5,6 it may be hypothesized that the interventions in the present study 1 were effective when they resulted in a reduction in driving pressure, which might be tested in a post hoc analysis. In addition, it would be informative to analyze the effects of lowering tidal volume in patients with a lower respiratory system compliance.…”

Section: To the Editormentioning

confidence: 99%

Tidal Volume, Positive End-expiratory Pressure, and Postoperative Hypoxemia: Comment

Suleiman¹,

Baedorf‐Kassis²,

Talmor³

et al. 2023

Anesthesiology

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Association between intraoperative tidal volume and postoperative respiratory complications is dependent on respiratory elastance: a retrospective, multicentre cohort study

Cited by 16 publications

References 47 publications

Mechanical power and 30-day mortality in mechanically ventilated, critically ill patients with and without Coronavirus Disease-2019: a hospital registry study

Mechanical power and 30-day mortality in mechanically ventilated, critically ill patients with and without Coronavirus Disease-2019: a hospital registry study

Association of preoperative spirometry tests with postoperative pulmonary complications after mediastinal mass resection: protocol for a retrospective cohort study

Tidal Volume, Positive End-expiratory Pressure, and Postoperative Hypoxemia: Comment

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