Details

Autor(en) / Beteiligte

• Li, Xue-Fei
• Jiang, Rong-Juan
• Mao, Wen-Jie
• Yu, Hong
• Xin, Juan
• Yu, Hai

Titel

The effect of driving pressure-guided versus conventional mechanical ventilation strategy on pulmonary complications following on-pump cardiac surgery: A randomized clinical trial

Ist Teil von

• Journal of clinical anesthesia, 2023-10, Vol.89, p.111150-111150, Article 111150

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2023

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Postoperative pulmonary complications occur frequently and are associated with worse postoperative outcomes in cardiac surgical patients. The advantage of driving pressure-guided ventilation strategy in decreasing pulmonary complications remains to be definitively established. We aimed to investigate the effect of intraoperative driving pressure-guided ventilation strategy compared with conventional lung-protective ventilation on pulmonary complications following on-pump cardiac surgery. Prospective, two-arm, randomized controlled trial. The West China university hospital in Sichuan, China. Adult patients who were scheduled for elective on-pump cardiac surgery were enrolled in the study. Patients undergoing on-pump cardiac surgery were randomized to receive driving pressure-guided ventilation strategy based on positive end-expiratory pressure (PEEP) titration or conventional lung-protective ventilation strategy with fixed 5 cmH2O of PEEP. The primary outcome of pulmonary complications (including acute respiratory distress syndrome, atelectasis, pneumonia, pleural effusion, and pneumothorax) within the first 7 postoperative days were prospectively identified. Secondary outcomes included pulmonary complication severity, ICU length of stay, and in-hospital and 30-day mortality. Between August 2020 and July 2021, we enrolled 694 eligible patients who were included in the final analysis. Postoperative pulmonary complications occurred in 140 (40.3%) patients in the driving pressure group and 142 (40.9%) in the conventional group (relative risk, 0.99; 95% confidence interval, 0.82–1.18; P = 0.877). Intention-to-treat analysis showed no significant difference between study groups regarding the incidence of primary outcome. The driving pressure group had less atelectasis than the conventional group (11.5% vs 17.0%; relative risk, 0.68; 95% confidence interval, 0.47–0.98; P = 0.039). Secondary outcomes did not differ between groups. Among patients who underwent on-pump cardiac surgery, the use of driving pressure-guided ventilation strategy did not reduce the risk of postoperative pulmonary complications when compared with conventional lung-protective ventilation strategy. •The advantage of driving pressure-guided ventilation strategy in preventing pulmonary complications remains to be established.•Whether driving pressure-guided ventilation benefits patients undergoing cardiac surgery has not been studied.•The results showed that the dynamic compliance in the driving pressure group wasbetter than that in the conventional group.•Driving pressure-guided ventilation strategy did not reduce the risk of pulmonary complications in patients undergoing cardiac surgery.