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Airway driving pressure is associated with postoperative pulmonary complications after major abdominal surgery: a
Nicholas J Douville1,2,3, Timothy L McMurry4, Jennie Z Ma4
1Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI, USA.
Insights
High airway driving pressure during major abdominal surgery is linked to increased postoperative pulmonary complications. This finding highlights driving pressure as a key risk factor for adverse outcomes in surgical patients.
Area of Science:
- Critical care medicine
- Anesthesiology
- Pulmonary medicine
Background:
- High airway driving pressure is linked to poor outcomes in mechanically ventilated patients.
- Limited multicentre data exist on driving pressure during major surgery.
- This study investigates driving pressure's role in major abdominal surgery complications.
Purpose of the Study:
- To determine if increased driving pressure during major abdominal surgery is associated with postoperative pulmonary complications.
- To identify predictors of higher dynamic driving pressure in this patient population.
Main Methods:
- Multicentre retrospective observational cohort study of 14,218 patients undergoing major abdominal surgery.
- Primary outcome: composite of postoperative pneumonia, unplanned tracheal intubation, or prolonged mechanical ventilation (>48h).
- Adjusted analysis of intraoperative dynamic driving pressure and outcomes, controlling for patient and procedural factors.
Main Results:
- 2.7% of patients experienced postoperative pulmonary complications.
- Mean dynamic driving pressure was associated with postoperative pulmonary complications (aOR 1.04 per 1 cm H2O increase).
- Tidal volume and PEEP were not associated; higher BMI, shorter height, and female sex predicted higher driving pressure.
Conclusions:
- Dynamic airway driving pressure, not tidal volume or PEEP, is associated with postoperative pulmonary complications after major abdominal surgery.
- Risk prediction models incorporating driving pressure can be applied to individual patients.
- Driving pressure is a significant modifiable factor for preventing pulmonary complications in surgical settings.
Background:
High airway driving pressure is associated with adverse outcomes in critically ill patients receiving mechanical ventilation, but large multicentre studies investigating airway driving pressure during major surgery are lacking. We hypothesised that increased driving pressure is associated with postoperative pulmonary complications in patients undergoing major abdominal surgery.
Methods:
In this preregistered multicentre retrospective observational cohort study, the authors reviewed major abdominal surgical procedures in 11 hospitals from 2004 to 2018. The primary outcome was a composite of postoperative pulmonary complications, defined as postoperative pneumonia, unplanned tracheal intubation, or prolonged mechanical ventilation for more than 48 h. Associations between intraoperative dynamic driving pressure and outcomes, adjusted for patient and procedural factors, were evaluated.
Results:
Among 14 218 qualifying cases, 389 (2.7%) experienced postoperative pulmonary complications. After adjustment, the mean dynamic driving pressure was associated with postoperative pulmonary complications (adjusted odds ratio for every 1 cm H2O increase: 1.04; 95% confidence interval [CI], 1.02-1.06; P<0.001). Neither tidal volume nor PEEP was associated with postoperative pulmonary complications. Increased BMI, shorter height, and female sex were predictors for higher dynamic driving pressure (β=0.35, 95% CI 0.32-0.39, P<0.001; β=-0.01, 95% CI -0.02 to 0.00, P=0.005; and β=0.74, 95% CI 0.63-0.86, P<0.001, respectively).
Conclusions:
Dynamic airway driving pressure, but not tidal volume or PEEP, is associated with postoperative pulmonary complications in models controlling for a large number of risk predictors and covariates. Such models are capable of risk prediction applicable to individual patients.
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