Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data

Summary Background Protective mechanical ventilation strategies using low tidal volume or high levels of positive end-expiratory pressure (PEEP) improve outcomes for patients who have had surgery. The role of the driving pressure, which is the difference between the plateau pressure and the level of...

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Veröffentlicht in:	The lancet respiratory medicine 2016-04, Vol.4 (4), p.272-280
Hauptverfasser:	Neto, Ary Serpa, Prof, Hemmes, Sabrine N T, MD, Barbas, Carmen S V, Prof, Beiderlinden, Martin, MD, Fernandez-Bustamante, Ana, MD, Futier, Emmanuel, Prof, Gajic, Ognjen, Prof, El-Tahan, Mohamed R, MD, Ghamdi, Abdulmohsin A Al, MD, Günay, Ersin, MD, Jaber, Samir, Prof, Kokulu, Serdar, MD, Kozian, Alf, MD, Licker, Marc, MD, Lin, Wen-Qian, MD, Maslow, Andrew D, MD, Memtsoudis, Stavros G, MD, Miranda, Dinis Reis, MD, Moine, Pierre, MD, Ng, Thomas, MD, Paparella, Domenico, MD, Ranieri, V Marco, Prof, Scavonetto, Federica, MD, Schilling, Thomas, MD, Selmo, Gabriele, MD, Severgnini, Paolo, MD, Sprung, Juraj, Prof, Sundar, Sugantha, MD, Talmor, Daniel, MD, Treschan, Tanja, MD, Unzueta, Carmen, MD, Weingarten, Toby N, MD, Wolthuis, Esther K, MD, Wrigge, Hermann, Prof, Amato, Marcelo B P, Prof, Costa, Eduardo L V, MD, de Abreu, Marcelo Gama, Prof, Pelosi, Paolo, FERS, Schultz, Marcus J, Prof
Format:	Artikel
Sprache:	eng
Schlagworte:	Adult Aged Anesthesia, General - adverse effects Anesthesia, General - methods Female Humans Intraoperative Period Life Sciences Lung Diseases - etiology Male Middle Aged Positive-Pressure Respiration - adverse effects Positive-Pressure Respiration - methods Postoperative Complications - etiology Pulmonary/Respiratory Randomized Controlled Trials as Topic Tidal Volume
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Zusammenfassung:	Summary Background Protective mechanical ventilation strategies using low tidal volume or high levels of positive end-expiratory pressure (PEEP) improve outcomes for patients who have had surgery. The role of the driving pressure, which is the difference between the plateau pressure and the level of positive end-expiratory pressure is not known. We investigated the association of tidal volume, the level of PEEP, and driving pressure during intraoperative ventilation with the development of postoperative pulmonary complications. Methods We did a meta-analysis of individual patient data from randomised controlled trials of protective ventilation during general anesthaesia for surgery published up to July 30, 2015. The main outcome was development of postoperative pulmonary complications (postoperative lung injury, pulmonary infection, or barotrauma). Findings We included data from 17 randomised controlled trials, including 2250 patients. Multivariate analysis suggested that driving pressure was associated with the development of postoperative pulmonary complications (odds ratio [OR] for one unit increase of driving pressure 1·16, 95% CI 1·13–1·19; p
ISSN:	2213-2600 2213-2619
DOI:	10.1016/S2213-2600(16)00057-6