Intraoperative mechanical ventilation practice in thoracic surgery patients and its association with postoperative pulmonary complications: Results of a multicenter prospective observational study

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Christopher Uhlig - , TUD Dresden University of Technology (Author)
  • Ary Serpa Neto - , Hospital Israelita Albert Einstein (Author)
  • Meta Van Der Woude - , University of Amsterdam (Author)
  • Thomas Kiss - , Department of Anesthesiology and Intensive Care Medicine (Author)
  • Jakob Wittenstein - , Department of Anesthesiology and Intensive Care Medicine (Author)
  • Benjamin Shelley - , University of Glasgow (Author)
  • Helen Scholes - , University of Glasgow (Author)
  • Michael Hiesmayr - , Medical University of Vienna (Author)
  • Marcos Francisco Vidal Melo - , Harvard University (Author)
  • Daniele Sances - , IRCCS Istituto Europeo di Oncologia - Milano (Author)
  • Nesil Coskunfirat - , Akdeniz University (Author)
  • Paolo Pelosi - , University of Genoa (Author)
  • Marcus Schultz - , University of Amsterdam (Author)
  • Marcelo Gama De Abreu - , Department of Anesthesiology and Intensive Care Medicine (Author)

Abstract

Background: Intraoperative mechanical ventilation may influence postoperative pulmonary complications (PPCs). Current practice during thoracic surgery is not well described. Methods: This is a post-hoc analysis of the prospective multicenter cross-sectional LAS VEGAS study focusing on patients who underwent thoracic surgery. Consecutive adult patients receiving invasive ventilation during general anesthesia were included in a one-week period in 2013. Baseline characteristics, intraoperative and postoperative data were registered. PPCs were collected as composite endpoint until the 5th postoperative day. Patients were stratified into groups based on the use of one lung ventilation (OLV) or two lung ventilation (TLV), endoscopic vs. non-endoscopic approach and ARISCAT score risk for PPCs. Differences between subgroups were compared using χ2 or Fisher exact tests or Student's t-test. Kaplan-Meier estimates of the cumulative probability of development of PPC and hospital discharge were performed. Cox-proportional hazard models without adjustment for covariates were used to assess the effect of the subgroups on outcome. Results: From 10,520 patients enrolled in the LAS VEGAS study, 302 patients underwent thoracic procedures and were analyzed. There were no differences in patient characteristics between OLV vs. TLV, or endoscopic vs. open surgery. Patients received VT of 7.4 ± 1.6 mL/kg, a PEEP of 3.5 ± 2.4 cmH2O, and driving pressure of 14.4 ± 4.6 cmH2O. Compared with TLV, patients receiving OLV had lower VT and higher peak, plateau and driving pressures, higher PEEP and respiratory rate, and received more recruitment maneuvers. There was no difference in the incidence of PPCs in OLV vs. TLV or in endoscopic vs. open procedures. Patients at high risk had a higher incidence of PPCs compared with patients at low risk (48.1% vs. 28.9%; hazard ratio, 1.95; 95% CI 1.05-3.61; p = 0.033). There was no difference in the incidence of severe PPCs. The in-hospital length of stay (LOS) was longer in patients who developed PPCs. Patients undergoing OLV, endoscopic procedures and at low risk for PPC had shorter LOS. Conclusion: PPCs occurred frequently and prolonged hospital LOS following thoracic surgery. Proportionally large tidal volumes and high driving pressure were commonly used in this sub-population. However, large RCTs are needed to confirm these findings. Trial registration: This trial was prospectively registered at the Clinical Trial Register (www.clinicaltrials.gov; NCT01601223; registered May 17, 2012.)

Details

Original languageEnglish
Article number179
JournalBMC anesthesiology
Volume20
Issue number1
Publication statusPublished - 22 Jul 2020
Peer-reviewedYes

External IDs

PubMed 32698775
ORCID /0000-0003-4397-1467/work/142238071

Keywords

ASJC Scopus subject areas

Keywords

  • General anesthesia, Mechanical ventilation, Perioperative complications, Thoracic surgery