High Mechanical Power and Driving Pressures are Associated With Postoperative Respiratory Failure Independent From Patients' Respiratory System Mechanics.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
01 Jan 2024
01 Jan 2024
Historique:
pubmed:
11
9
2023
medline:
11
9
2023
entrez:
11
9
2023
Statut:
ppublish
Résumé
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. Hospital registry study. Academic hospital in New England. Adult patients undergoing general anesthesia between 2008 and 2020. None. 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 H 2 O) 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 H 2 O; 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). 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.
Identifiants
pubmed: 37695139
doi: 10.1097/CCM.0000000000006038
pii: 00003246-990000000-00204
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
68-79Informations de copyright
Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Déclaration de conflit d'intérêts
Drs. Talmor and Baedorf-Kassis received funding from Hamilton Medical. Drs. Talmor and Schaefer received funding from Mindray Medical. Dr. Amato’s institution received funding from Covidien/Mdtronics, Orange Med/Nihon Kohden, and Timpel; he disclosed that he is a minority shareholder in Timpel. Dr. Schaefer received funding from Jeffrey and Judy Buzen, Merck & Co., and Fisher and Paykel Healthcare; he disclosed that he is an Associate Editor for BMC Anesthesiology. The remaining authors have disclosed that they do not have any potential conflicts of interest.
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