Individualized positive end-expiratory pressure guided by respiratory mechanics during anesthesia for the prevention of postoperative pulmonary complications: a systematic review and meta-analysis

Zhou, Li; Li, Hongmei; Li, Mingjuan; Liu, Li

doi:10.1007/s10877-022-00960-9

Cited by 6 publications

(1 citation statement)

References 49 publications

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“…Clinical trials investigating the effect of nonindividualized PEEP have shown equivocal results (41, 42). Strategies aiming to individualize PEEP strategies based on patient’s respiratory system compliance have been linked to lower postoperative complications in high-risk scenarios (43, 44).…”

Section: Discussionmentioning

confidence: 99%

High Mechanical Power and Driving Pressures are Associated With Postoperative Respiratory Failure Independent From Patients’ Respiratory System Mechanics*

Tartler,

Ahrens,

Munoz-Acuna

et al. 2023

Critical Care Medicine

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Objectives: High mechanical power and driving pressure (ΔP) have been associated with postoperative respiratory failure (PRF) and may be important parameters guiding mechanical ventilation. However, it remains unclear whether high mechanical power and ΔP merely reflect patients with poor respiratory system mechanics at risk of PRF. We investigated the effect of mechanical power and ΔP on PRF in cohorts after exact matching by patients’ baseline respiratory system compliance. Design: Hospital registry study. Setting: Academic hospital in New England. Patients: Adult patients undergoing general anesthesia between 2008 and 2020. Intervention: None. Measurements and Main Results: The primary exposure was high (≥ 6.7 J/min, cohort median) versus low mechanical power and the key-secondary exposure was high (≥ 15.0 cm H2O) versus low ΔP. The primary endpoint was PRF (reintubation or unplanned noninvasive ventilation within seven days). Among 97,555 included patients, 4,030 (4.1%) developed PRF. In adjusted analyses, high intraoperative mechanical power and ΔP were associated with higher odds of PRF (adjusted odds ratio [aOR] 1.37 [95% CI, 1.25–1.50]; p < 0.001 and aOR 1.45 [95% CI, 1.31–1.60]; p < 0.001, respectively). There was large variability in applied ventilatory parameters, dependent on the anesthesia provider. This facilitated matching of 63,612 (mechanical power cohort) and 53,260 (ΔP cohort) patients, yielding identical baseline standardized respiratory system compliance (standardized difference [SDiff] = 0.00) with distinctly different mechanical power (9.4 [2.4] vs 4.9 [1.3] J/min; SDiff = –2.33) and ΔP (19.3 [4.1] vs 11.9 [2.1] cm H2O; SDiff = –2.27). After matching, high mechanical power and ΔP remained associated with higher risk of PRF (aOR 1.30 [95% CI, 1.17–1.45]; p < 0.001 and aOR 1.28 [95% CI, 1.12–1.46]; p < 0.001, respectively). Conclusions: High mechanical power and ΔP are associated with PRF independent of patient’s baseline respiratory system compliance. Our findings support utilization of these parameters for titrating mechanical ventilation in the operating room and ICU.

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