Driving Pressure and Transpulmonary Pressure

Williams, Emily C.; Ribeiro, Gabriel; Melo, Marcos F. Vidal

doi:10.1097/aln.0000000000002731

Cited by 66 publications

(46 citation statements)

References 58 publications

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“…In contrast to the findings of recent studies on patients who did not have COPD, PEEP [28] and driving pressure [8,29] were not significantly associated with PPC risk in the present study. These conflicting results can be also explained by lung hyperinflation, which leads to intrinsic PEEP in patients with COPD.…”

Section: Discussioncontrasting

confidence: 99%

“…In the same manner, it can be deduced that the driving pressure (plateau pressure minus PEEP) was overestimated because we considered the PEEP generated by the ventilator instead of the actual PEEP in the alveolar unit. Because the driving pressure of the 419 patients was 9 (8-11) cmH 2 O, the actual driving pressure in the alveolar unit might have been lower than 14-18 cmH 2 O, which is thought be a safe range for preventing lung injury [29], even in patients with the highest quartile driving pressure.…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative Anesthetic Management of Patients with Chronic Obstructive Pulmonary Disease to Decrease the Risk of Postoperative Pulmonary Complications after Abdominal Surgery

Park

Han

et al. 2020

JCM

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Patients with chronic obstructive pulmonary disease (COPD) exhibit airflow limitation and suboptimal lung function, and they are at high risk of developing postoperative pulmonary complications (PPCs). We aimed to determine the factors that would decrease PPC risk in patients with COPD. We retrospectively analyzed 419 patients with COPD who were registered in our institutional PPC database and had undergone an abdominal surgery under general anesthesia. PPCs comprised respiratory failure, pleural effusion, atelectasis, respiratory infection, and bronchospasm; the presence or type of PPC was diagnosed by respiratory physicians and recorded in the database before this study. Binary logistic regression was used for statistical analysis. Of the 419 patients, 121 patients (28.8%) experienced 200 PPCs. Multivariable analysis showed three modifiable anesthetic factors that could decrease PPC risk: low tidal volume ventilation, restricted fluid infusion, and sugammadex-induced neuromuscular blockade reversal. We found that the 90-day mortality risk was significantly greater in patients with PPC than in those without PPC (5.8% vs. 1.3%; p = 0.016). Therefore, PPC risk in patients with COPD can be decreased if low tidal volume ventilation, restricted fluid infusion, and sugammadex-induced reversal during abdominal surgery are efficiently managed, as these factors result in decreased postoperative mortality.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intraoperative Anesthetic Management of Patients with Chronic Obstructive Pulmonary Disease to Decrease the Risk of Postoperative Pulmonary Complications after Abdominal Surgery

Park

Han

et al. 2020

JCM

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“…ΔP is an indicator of the amount of strain delivered to the respiratory system during mechanical ventilation [ 7 ]. Several studies investigated the effect of pneumoperitoneum on respiratory mechanics.…”

Section: Discussionmentioning

confidence: 99%

“…The overall behaviour of the respiratory system depends on the properties of its components, i.e., the artificial and native airways, and the lung tissue, but also the chest wall consisting of the rib cage and diaphragm. Most of the force applied during invasive ventilation is needed to expand the chest wall, and only a lesser amount to inflate lung tissue [ 7 ]. When the chest wall elastance increases, e.g., during pneumoperitoneum, the ΔP increases, even when V T is left unchanged [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

The Association of Intraoperative driving pressure with postoperative pulmonary complications in open versus closed abdominal surgery patients – a posthoc propensity score–weighted cohort analysis of the LAS VEGAS study

et al. 2021

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Background It is uncertain whether the association of the intraoperative driving pressure (ΔP) with postoperative pulmonary complications (PPCs) depends on the surgical approach during abdominal surgery. Our primary objective was to determine and compare the association of time–weighted average ΔP (ΔPTW) with PPCs. We also tested the association of ΔPTW with intraoperative adverse events. Methods Posthoc retrospective propensity score–weighted cohort analysis of patients undergoing open or closed abdominal surgery in the ‘Local ASsessment of Ventilatory management during General Anaesthesia for Surgery’ (LAS VEGAS) study, that included patients in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs. The secondary endpoint was a composite of intraoperative adverse events. Results The analysis included 1128 and 906 patients undergoing open or closed abdominal surgery, respectively. The PPC rate was 5%. ΔP was lower in open abdominal surgery patients, but ΔPTW was not different between groups. The association of ΔPTW with PPCs was significant in both groups and had a higher risk ratio in closed compared to open abdominal surgery patients (1.11 [95%CI 1.10 to 1.20], P < 0.001 versus 1.05 [95%CI 1.05 to 1.05], P < 0.001; risk difference 0.05 [95%CI 0.04 to 0.06], P < 0.001). The association of ΔPTW with intraoperative adverse events was also significant in both groups but had higher odds ratio in closed compared to open abdominal surgery patients (1.13 [95%CI 1.12– to 1.14], P < 0.001 versus 1.07 [95%CI 1.05 to 1.10], P < 0.001; risk difference 0.05 [95%CI 0.030.07], P < 0.001). Conclusions ΔP is associated with PPC and intraoperative adverse events in abdominal surgery, both in open and closed abdominal surgery. Trial registration LAS VEGAS was registered at clinicaltrials.gov (trial identifier NCT01601223).

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“…Intrathoracic pressures during mechanical ventilation reflect disease in the lung parenchyma, pleural space, chest wall, and abdomen. 1 Premorbid conditions, such as COPD, congestive heart failure, and obesity, influence the severity of any acute presentation. In addition, obesity has potential effects on both the lung parenchyma and the chest wall.…”

Section: Introductionmentioning

confidence: 99%

The Association Between the Mechanical Ventilator Pressures and Outcomes in a Cohort of Patients with Acute Respiratory Failure

Edriss¹,

Yang

Juarez

et al. 2020

Clin Med Insights Circ Respir Pulm Med

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Background: Pressures measured during mechanical ventilation provide important information about the respiratory system mechanics and can help predict outcomes. Methods: The electronic medical records of patients hospitalized between 2010 and 2016 with sepsis who required mechanical ventilation were reviewed to collect demographic information, clinical information, management requirements, and outcomes, such as mortality, ICU length of stay, and hospital length of stay. Mechanical ventilation pressures were recorded on the second full day of hospitalization. Results: This study included 312 adult patients. The mean age is 59.1 ± 16.3 years; 57.4% were men. The mean BMI was 29.3 ± 10.7. Some patients had pulmonary infections (46.2%), and some patients had extrapulmonary infections (34.9%). The overall mortality was 42.6%. In a multi-variable model that included age, gender, number of comorbidities, APACHE 2 score, and PaO2/FiO2 ratio, peak pressure, plateau pressure, driving pressure, and PEEP all predicted mortality when entered into the model separately. There was an increase in peak pressure, plateau pressure, and driving pressure across BMI categories ranging from underweight to obese. Conclusions: This study demonstrates that ventilator pressure measurements made early during the management of patients with acute respiratory failure requiring mechanical ventilation provide prognostic information regarding outcomes, including mortality. Patients with high mechanical ventilator pressures during the early course of their acute respiratory failure require more attention to identify reversible disease processes when possible. In addition, increased BMIs are associated with increased ventilator pressures, and this increases the complexity of the clinical evaluation in the management of obese patients.

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Driving Pressure and Transpulmonary Pressure

Abstract: The physiologic concept, pathophysiologic implications, and clinical relevance and application of driving pressure and transpulmonary pressure to prevent ventilator-induced lung injury are discussed.

Cited by 66 publications

References 58 publications

Intraoperative Anesthetic Management of Patients with Chronic Obstructive Pulmonary Disease to Decrease the Risk of Postoperative Pulmonary Complications after Abdominal Surgery

Intraoperative Anesthetic Management of Patients with Chronic Obstructive Pulmonary Disease to Decrease the Risk of Postoperative Pulmonary Complications after Abdominal Surgery

The Association of Intraoperative driving pressure with postoperative pulmonary complications in open versus closed abdominal surgery patients – a posthoc propensity score–weighted cohort analysis of the LAS VEGAS study

The Association Between the Mechanical Ventilator Pressures and Outcomes in a Cohort of Patients with Acute Respiratory Failure

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