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High driving pressure linked to postoperative complications

Patients are more likely to have pulmonary complications if there is intraoperative driving pressure and changes in the level of positive end-expiratory pressure during surgery, according to research.

To determine the association between tidal volume, PEEP level and driving pressure, Ary Serpa Neto, MD, from the Department of Intensive Care in the Academic Medical Center at the University of Amsterdam in Amsterdam, Netherlands, and colleagues performed a meta-analysis of 17 studies (2,250 patients) Inclusion criteria for studies were patients who underwent protective ventilation during general anesthesia for surgery with outcomes for postoperative pulmonary complications, such as pulmonary infection, lung injury and barotrauma.

Neto and colleagues found that driving pressure was associated with pulmonary complications, with one unit of driving pressure carrying an odds ratio (OR) of 1.16 (95% CI, 1.13 – 1.19; P < 0.0001), according to the abstract. In a multivariate analysis, Neto and colleagues found no association between tidal volume and pulmonary complications (OR = 1.05; 95% CI, 0.98-1.13; P = 0.179), and a univariate analysis showed PEEP did not display a large enough effect to be included in the multivariate analysis. When performing a mediator analysis, driving force alone was the only factor associated with pulmonary complications (P = 0.027).

Of two studies analyzing tidal pressure ventilation, high and low PEEP, Neto and colleagues found an increase in PEEP level resulting in an increase in driving pressure was associated with an increase in pulmonary complications (OR = 3.11; 95% CI, 1.39-6.96; P = 0.006), according to the abstract.

“To confirm these findings, a randomised controlled trial comparing ventilation based on driving pressure versus usual care is necessary,” Neto and colleagues wrote. – by Jeff Craven

Disclosure: The researchers report no relevant financial disclosures.