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Driving pressure-guided ventilation and postoperative pulmonary complications in thoracic surgery: a multicentre randomised clinical trial

 MiHye Park  ;  Susie Yoon  ;  Jae-Sik Nam  ;  Hyun Joo Ahn  ;  Heezoo Kim  ;  Hye Jin Kim  ;  Hoon Choi  ;  Hong Kwan Kim  ;  Randal S Blank  ;  Sung-Cheol Yun  ;  Dong Kyu Lee  ;  Mikyung Yang  ;  Jie Ae Kim  ;  Insun Song  ;  Bo Rim Kim  ;  Jae-Hyon Bahk  ;  Juyoun Kim  ;  Sangho Lee  ;  In-Cheol Choi  ;  Young Jun Oh  ;  Wonjung Hwang  ;  Byung Gun Lim  ;  Burn Young Heo 
 BRITISH JOURNAL OF ANAESTHESIA, Vol.130(1) : E106-E118, 2022-01 
Journal Title
Issue Date
Female ; Humans ; Lung ; Male ; Middle Aged ; Positive-Pressure Respiration / adverse effects ; Postoperative Complications / epidemiology ; Postoperative Complications / etiology ; Postoperative Complications / prevention & control ; Thoracic Surgery* ; Thoracic Surgical Procedures* / adverse effects ; Tidal Volume
airway driving pressure ; lung protective ventilation ; positive end-expiratory pressure ; postoperative pulmonary complications ; thoracic surgery
Background: Airway driving pressure, easily measured as plateau pressure minus PEEP, is a surrogate for alveolar stress and strain. However, the effect of its targeted reduction remains unclear.

Methods: In this multicentre trial, patients undergoing lung resection surgery were randomised to either a driving pressure group (n=650) receiving an alveolar recruitment/individualised PEEP to deliver the lowest driving pressure or to a conventional protective ventilation group (n=650) with fixed PEEP of 5 cm H2O. The primary outcome was a composite of pulmonary complications within 7 days postoperatively.

Results: The modified intention-to-treat analysis included 1170 patients (mean [standard deviation, sd]; age, 63 [10] yr; 47% female). The mean driving pressure was 7.1 cm H2O in the driving pressure group vs 9.2 cm H2O in the protective ventilation group (mean difference [95% confidence interval, CI]; -2.1 [-2.4 to -1.9] cm H2O; P<0.001). The incidence of pulmonary complications was not different between the two groups: driving pressure group (233/576, 40.5%) vs protective ventilation group (254/594, 42.8%) (risk difference -2.3%; 95% CI, -8.0% to 3.3%; P=0.42). Intraoperatively, lung compliance (mean [sd], 42.7 [12.4] vs 33.5 [11.1] ml cm H2O-1; P<0.001) and Pao2 (median [inter-quartile range], 21.5 [14.5 to 30.4] vs 19.5 [13.5 to 29.1] kPa; P=0.03) were higher and the need for rescue ventilation was less frequent (6.8% vs 10.8%; P=0.02) in the driving pressure group.

Conclusions: In lung resection surgery, a driving pressure-guided ventilation improved pulmonary mechanics intraoperatively, but did not reduce the incidence of postoperative pulmonary complications compared with a conventional protective ventilation.

Clinical trial registration: NCT04260451.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hye Jin(김혜진) ORCID logo https://orcid.org/0000-0003-3452-477X
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