Driving Pressure during Thoracic Surgery: A Randomized Clinical Trial.

Area of Science:

• Anesthesiology and critical care medicine
• Thoracic surgery
• Mechanical ventilation

Background:

• Driving pressure is a key metric in acute respiratory distress syndrome and general anesthesia.
• Its role in thoracic anesthesia, where lungs are isolated and inflated, remains under-investigated.
• Retrospective studies suggest driving pressure is a significant predictor of pulmonary complications.

Purpose of the Study:

• To compare the efficacy of driving pressure-guided ventilation versus conventional protective ventilation.
• To determine if driving pressure-guided ventilation reduces postoperative pulmonary complications in thoracic surgery.

Main Methods:

• A double-blind, randomized controlled trial involving 292 patients undergoing elective thoracic surgery.
• One group received conventional protective ventilation (tidal volume 6 mL/kg IBW, PEEP 5 cm H2O, recruitment maneuver).
• The other group received driving pressure-guided ventilation with individualized PEEP to minimize driving pressure (plateau pressure - PEEP) during one-lung ventilation.

Main Results:

• Postoperative pulmonary complications (Melbourne Group Scale ≥4) occurred in 5.5% of the driving pressure group vs. 12.2% of the conventional group (P=0.047).
• Pneumonia or acute respiratory distress syndrome incidence was lower in the driving pressure group (6.9% vs. 15.0%, P=0.028).
• Driving pressure-guided ventilation showed an odds ratio of 0.42 for both primary and secondary outcomes.

Conclusions:

• Driving pressure-guided ventilation is associated with a lower incidence of postoperative pulmonary complications.
• This ventilation strategy appears beneficial in thoracic surgery patients undergoing one-lung ventilation.
• Minimizing driving pressure may be a crucial lung-protective strategy in this setting.