Intensity of one-lung ventilation and postoperative respiratory failure: A hospital registry study*

被引：7

作者：

Suleiman, Aiman ^{[1
,2
]}

Azizi, Basit A. ^{[1
,2
]}

Munoz-Acuna, Ricardo ^{[1
,2
]}

Ahrens, Elena ^{[1
,2
]}

Tartler, Tim M. ^{[1
,2
]}

Wachtendorf, Luca J. ^{[1
,2
]}

Linhardt, Felix C. ^{[1
,2
]}

Santer, Peter ^{[2
]}

Chen, Guanqing ^{[1
,2
]}

Wilson, Jennifer L. ^{[3
]}

Gangadharan, Sidhu P. ^{[3
]}

Schaefer, Maximilian S. ^{[1
,2
,4
,5
]}

机构：

[1] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Dept Anesthesia Crit Care & Pain Med, Boston, MA USA

[2] Harvard Med Sch, Ctr Anesthesia Res Excellence CARE, Beth Israel Deaconess Med Ctr, Boston, MA USA

[3] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Dept Surg, Div Thorac Surg & Intervent Pulmonol, Boston, MA USA

[4] Duesseldorf Univ Hosp, Dept Anesthesiol, Dusseldorf, Germany

[5] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Dept Anesthesia Crit Care & Pain Med, 330 Brookline Ave, Boston, MA 02215 USA

来源：

ANAESTHESIA CRITICAL CARE & PAIN MEDICINE | 2023年 / 42卷 / 05期

关键词：

One-lung ventilation; Intensity of ventilation; Mechanical power; Driving pressure; Thoracic surgeries; Postoperative respiratory failure; MECHANICAL POWER; PULMONARY COMPLICATIONS; GENERAL-ANESTHESIA; THORACIC-SURGERY; DRIVING PRESSURE; TIDAL VOLUME; MORTALITY; RESECTION; ASSOCIATION; CANCER;

D O I：

10.1016/j.accpm.2023.101250

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

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. ⠂C 2023 Societefranc,aise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

引用

页数：7

共 35 条

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