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Intraoperative ventilator settings and acute lung injury after elective surgery: a nested case control study
E R Fernández-Pérez1, J Sprung, B Afessa
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Jewish Health, 1400 Jackson Street, G10a, Denver, CO 80206, USA. FernandezEvans@njc.org
Thorax
|November 8, 2008
Summary
Acute lung injury (ALI) is a common cause of postoperative respiratory failure, significantly reducing survival rates. Intraoperative tidal volume does not appear to increase the risk of developing ALI.
Area of Science:
- Critical Care Medicine
- Pulmonary Medicine
- Surgical Outcomes
Background:
- Acute lung injury (ALI) is a severe postoperative complication with poorly understood incidence and risk factors.
- Prospective studies are needed to clarify the impact of ALI on patient outcomes.
Purpose of the Study:
- To determine the incidence and survival associated with ALI-related postoperative respiratory failure.
- To investigate the association between intraoperative ventilator settings, specifically tidal volume, and ALI development.
Main Methods:
- Prospective, nested case-control study at a single tertiary referral center.
- Included 4420 patients undergoing high-risk elective surgery without ALI.
- Assessed ALI incidence, survival, and risk factors, including intraoperative exposures.
Main Results:
- 5.4% of patients developed postoperative respiratory failure, with ALI being the most common cause (35%).
- ALI cases exhibited significantly lower 60-day and 1-year survival rates compared to controls.
- Higher peak airway pressure was associated with ALI, but tidal volume, PEEP, and FiO2 were not significant risk factors.
Conclusions:
- ALI is the leading cause of postoperative respiratory failure and is linked to substantially decreased survival.
- Intraoperative tidal volume does not appear to be a risk factor for early postoperative ALI.
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