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Intraoperative Driving Pressure and Postoperative Pulmonary Complications Following Cardiac Surgery: A Prospective
Canan Yılmaz1, Filiz Ata1, Selimcan Yırtımcı2
1Department of Anesthesiology and Reanimation, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Yıldırım 16310, Bursa, Türkiye.
Medicina (Kaunas, Lithuania)
|June 26, 2026
Summary
Elevated driving pressure (DP) during cardiac surgery was linked to more postoperative pulmonary complications (PPCs) and longer recovery. However, DP was not an independent predictor of PPCs after accounting for other factors.
Area of Science:
- Anesthesiology
- Critical Care Medicine
- Thoracic Surgery
Background:
- Postoperative pulmonary complications (PPCs) are a significant cause of morbidity following cardiac surgery.
- Driving pressure (DP), a measure of respiratory system mechanics, is proposed as a bedside marker during mechanical ventilation.
- The association between intraoperative DP and PPCs in cardiac surgery patients undergoing cardiopulmonary bypass (CPB) is not well-established.
Purpose of the Study:
- To investigate the relationship between intraoperative driving pressure (DP) and the occurrence of postoperative pulmonary complications (PPCs) in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).
Main Methods:
- A prospective observational study included 99 adult patients undergoing elective cardiac surgery with CPB.
- Patients received lung-protective ventilation with a tidal volume of 6 mL/kg predicted body weight and PEEP of 5 cmH2O.
- Patients were grouped by intraoperative DP (<13 cmH2O or ≥13 cmH2O), and multivariable logistic regression analyzed DP's association with PPCs, adjusting for BMI, CPB time, and age.
Main Results:
- Patients with DP ≥13 cmH2O experienced higher rates of pneumothorax, pleural effusion, atelectasis, CPAP requirement, and prolonged mechanical ventilation.
- Elevated DP was associated with longer mechanical ventilation, ICU, and hospital stays.
- While higher pre-CPB DP showed a trend towards increased PPC risk, it was not an independent predictor of the composite PPC endpoint after multivariable adjustment.
Conclusions:
- Elevated intraoperative DP correlates with a higher unadjusted burden of PPCs and delayed recovery after CPB-supported cardiac surgery.
- Pre-CPB DP is not an independent predictor of the composite PPC endpoint when adjusted for confounders.
- DP may indicate impaired respiratory mechanics and increased postoperative vulnerability rather than being a direct cause of PPCs.
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