The association of postoperative pulmonary complications in 109,360 patients with pressure‐controlled or volume‐controlled ventilation

Abstract

We thought that the rate of postoperative pulmonary complications might be higher after pressure-controlled ventilation than after volume-controlled ventilation. We analysed peri-operative data recorded for 109,360 adults, whose lungs were mechanically ventilated during surgery at three hospitals in Massachusetts, USA. We used multivariable regression and propensity score matching. Postoperative pulmonary complications were more common after pressure-controlled ventilation, odds ratio (95%CI) 1.29 (1.21-1.37), p < 0.001. Tidal volumes and driving pressures were more varied with pressure-controlled ventilation compared with volume-controlled ventilation: mean (SD) variance from the median 1.61 (1.36) ml.kg vs. 1.23 (1.11) ml.kg , p < 0.001; and 3.91 (3.47) cmH O vs. 3.40 (2.69) cmH O, p < 0.001. The odds ratio (95%CI) of pulmonary complications after pressure-controlled ventilation compared with volume-controlled ventilation at positive end-expiratory pressures < 5 cmH O was 1.40 (1.26-1.55) and 1.20 (1.11-1.31) when ≥ 5 cmH O, both p < 0.001, a relative risk ratio of 1.17 (1.03-1.33), p = 0.023. The odds ratio (95%CI) of pulmonary complications after pressure-controlled ventilation compared with volume-controlled ventilation at driving pressures of < 19 cmH O was 1.37 (1.27-1.48), p < 0.001, and 1.16 (1.04-1.30) when ≥ 19 cmH O, p = 0.011, a relative risk ratio of 1.18 (1.07-1.30), p = 0.016. Our data support volume-controlled ventilation during surgery, particularly for patients more likely to suffer postoperative pulmonary complications.

Intraoperative ventilator settings and their association with postoperative pulmonary complications in neurosurgical patients: post-hoc analysis of LAS VEGAS study

“…A recent randomized controlled trial during lumbar spine surgery demonstrated that hemodynamic variables and arterial blood gas results did not differ significantly between the VCV and PCV with volume guaranteed (PCV-VG) mode groups [13]. Also, a recent large observational study suggested that PCV is associated with increase of PPC compared to VCV [22]. This association is not confirmed by our results.…”

Perioperative lung protective ventilation

“…Small RCTs in laparoscopic bariatric surgery have yielded similar results 109110. No data from prospective trials are available to evaluate whether these benefits translate to improved clinical outcomes; however, a large database study involving more than 100 000 patients having elective surgery reported that use of PCV was associated with increased odds of developing a PPC (odds ratio 1.29, 1.21 to 1.37; P<0.001) 111. In this study, use of PCV predisposed to higher tidal volumes and driving pressures, a possible mechanism for the findings.…”

Mechanical ventilation mode and postoperative pulmonary complications

“…We thank Dr. McGuckin for his interest in our article [1] and appreciate the opportunity to respond to his queries. Dr. McGuckin raises the question of the applicability of our findings to patients' lungs being ventilated via supraglottic airways.…”