Intensity of one-lung ventilation and postoperative respiratory failure : A hospital registry study
Copyright © 2023 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved..
BACKGROUND: Studies linked a high intensity of mechanical ventilation, measured as high mechanical power (MP) to postoperative respiratory failure (PRF) in the setting of two-lung ventilation. We investigated whether a higher MP during one-lung ventilation (OLV) is associated with PRF.
METHODS: In this registry-based study, adult patients who underwent general anesthesia with OLV for thoracic surgeries between 2006 and 2020 at a New England tertiary healthcare network were included. The association between MP during OLV and PRF (emergency non-invasive ventilation or reintubation within seven days) was assessed in a cohort weighted through a generalized propensity score conditional on a priori defined preoperative and intraoperative factors. Dominance of components of MP and intensity of OLV versus two-lung ventilation in predicting PRF was investigated.
RESULTS: Out of 878 included patients, 106 (12.1%) developed PRF. The median (IQR) MP during OLV was 9.8 J/min (7.5-11.8) and 8.3 J/min (6.6-10.2) in patients with and without PRF respectively. A higher MP during OLV was associated with PRF (ORadj 1.22 per 1 J/min increase; 95%CI 1.13-1.31; p < 0.001) and characterized by a U-shaped dose-response curve, with the lowest probability of PRF (7.5%) at 6.4 J/min. Dominance analysis of PRF predictors showed a stronger contribution of driving pressure over respiratory rate and tidal volume, the dynamic over the static component of MP, and MP during OLV over two-lung ventilation (contribution to Pseudo-R2: 0.017, 0.021, and 0.036, respectively).
CONCLUSION: A higher intensity of OLV, mainly driven by driving pressure, is dose-dependently associated with PRF and might constitute a target for mechanical ventilation.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:42 |
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| Enthalten in: |
Anaesthesia, critical care & pain medicine - 42(2023), 5 vom: 25. Okt., Seite 101250 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Suleiman, Aiman [VerfasserIn] |
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| Links: |
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| Themen: |
Driving pressure |
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| Anmerkungen: |
Date Completed 25.09.2023 Date Revised 26.09.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.accpm.2023.101250 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM357385799 |
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| 100 | 1 | |a Suleiman, Aiman |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Intensity of one-lung ventilation and postoperative respiratory failure |b A hospital registry study |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved. | ||
| 520 | |a BACKGROUND: Studies linked a high intensity of mechanical ventilation, measured as high mechanical power (MP) to postoperative respiratory failure (PRF) in the setting of two-lung ventilation. We investigated whether a higher MP during one-lung ventilation (OLV) is associated with PRF | ||
| 520 | |a METHODS: In this registry-based study, adult patients who underwent general anesthesia with OLV for thoracic surgeries between 2006 and 2020 at a New England tertiary healthcare network were included. The association between MP during OLV and PRF (emergency non-invasive ventilation or reintubation within seven days) was assessed in a cohort weighted through a generalized propensity score conditional on a priori defined preoperative and intraoperative factors. Dominance of components of MP and intensity of OLV versus two-lung ventilation in predicting PRF was investigated | ||
| 520 | |a RESULTS: Out of 878 included patients, 106 (12.1%) developed PRF. The median (IQR) MP during OLV was 9.8 J/min (7.5-11.8) and 8.3 J/min (6.6-10.2) in patients with and without PRF respectively. A higher MP during OLV was associated with PRF (ORadj 1.22 per 1 J/min increase; 95%CI 1.13-1.31; p < 0.001) and characterized by a U-shaped dose-response curve, with the lowest probability of PRF (7.5%) at 6.4 J/min. Dominance analysis of PRF predictors showed a stronger contribution of driving pressure over respiratory rate and tidal volume, the dynamic over the static component of MP, and MP during OLV over two-lung ventilation (contribution to Pseudo-R2: 0.017, 0.021, and 0.036, respectively) | ||
| 520 | |a CONCLUSION: A higher intensity of OLV, mainly driven by driving pressure, is dose-dependently associated with PRF and might constitute a target for mechanical ventilation | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Driving pressure | |
| 650 | 4 | |a Intensity of ventilation | |
| 650 | 4 | |a Mechanical power | |
| 650 | 4 | |a One-lung ventilation | |
| 650 | 4 | |a Postoperative respiratory failure | |
| 650 | 4 | |a Thoracic surgeries | |
| 700 | 1 | |a Azizi, Basit A |e verfasserin |4 aut | |
| 700 | 1 | |a Munoz-Acuna, Ricardo |e verfasserin |4 aut | |
| 700 | 1 | |a Ahrens, Elena |e verfasserin |4 aut | |
| 700 | 1 | |a Tartler, Tim M |e verfasserin |4 aut | |
| 700 | 1 | |a Wachtendorf, Luca J |e verfasserin |4 aut | |
| 700 | 1 | |a Linhardt, Felix C |e verfasserin |4 aut | |
| 700 | 1 | |a Santer, Peter |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Guanqing |e verfasserin |4 aut | |
| 700 | 1 | |a Wilson, Jennifer L |e verfasserin |4 aut | |
| 700 | 1 | |a Gangadharan, Sidhu P |e verfasserin |4 aut | |
| 700 | 1 | |a Schaefer, Maximilian S |e verfasserin |4 aut | |
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