Dataset Information

Respiratory system compliance during anesthesia induction and postoperative mechanical ventilation needs: An observational study.

ABSTRACT:

Background and aims

Respiratory system compliance (Crs) is a simple indicator of lung flexibility. However, it remains unclear whether a low Crs during anesthesia induction (iCrs) is associated with an increased risk of postoperative mechanical ventilation.

Methods

This retrospective observational study was conducted using a local database. All mechanically ventilated postoperative ICU patients were included in this study. The duration of postoperative mechanical ventilation, length of hospital stay, and in-hospital mortality were compared between the low iCrs group (<25% of distribution) and the normal iCrs group.

Results

A total of 315 patients were classified into the low iCrs (<39 mL/cmH₂O) group (n = 78) or the normal iCrs group (n = 237). Low iCrs was associated with a higher chance of mechanical ventilation in 28 days (log-rank test, p < 0.001). The duration of hospital stay was similar. Multivariate analysis showed that in-hospital mortality was higher in the low iCrs group than in the normal iCrs group (adjusted odds ratio, 6.04 [1.13, 32.26]; p = 0.04).

Conclusion

Low iCrs was associated with an increased risk of requiring postoperative mechanical ventilation. An additional result of poor survival related to low iCrs may require further study.

SUBMITTER: Yamazaki Y

PROVIDER: S-EPMC11319399 | biostudies-literature | 2024 Aug

REPOSITORIES: biostudies-literature

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Publications

Respiratory system compliance during anesthesia induction and postoperative mechanical ventilation needs: An observational study.

Yamazaki Yukiko Y Matsuki Yuka Y Hosokawa Koji K Tanaka Katsuya K Kawamura Yuko Y Tanaka Aiko A Shigemi Kenji K

Health science reports 20240812 8

<h4>Background and aims</h4>Respiratory system compliance (Crs) is a simple indicator of lung flexibility. However, it remains unclear whether a low Crs during anesthesia induction (iCrs) is associated with an increased risk of postoperative mechanical ventilation.<h4>Methods</h4>This retrospective observational study was conducted using a local database. All mechanically ventilated postoperative ICU patients were included in this study. The duration of postoperative mechanical ventilation, leng ...[more]

PMID: 39139464

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Project description:ObjectiveTo evaluate the effects of intraoperative protective ventilation on major postoperative respiratory complications and to define safe intraoperative mechanical ventilator settings that do not translate into an increased risk of postoperative respiratory complications.DesignHospital based registry study.SettingAcademic tertiary care hospital and two affiliated community hospitals in Massachusetts, United States.Participants69,265 consecutively enrolled patients over the age of 18 who underwent a non-cardiac surgical procedure between January 2007 and August 2014 and required general anesthesia with endotracheal intubation.InterventionsProtective ventilation, defined as a median positive end expiratory pressure (PEEP) of 5 cmH2O or more, a median tidal volume of less than 10 mL/kg of predicted body weight, and a median plateau pressure of less than 30 cmH2O.Main outcome measureComposite outcome of major respiratory complications, including pulmonary edema, respiratory failure, pneumonia, and re-intubation.ResultsOf the 69,265 enrolled patients 34,800 (50.2%) received protective ventilation and 34,465 (49.8%) received non-protective ventilation intraoperatively. Protective ventilation was associated with a decreased risk of postoperative respiratory complications in multivariable regression (adjusted odds ratio 0.90, 95% confidence interval 0.82 to 0.98, P=0.013). The results were similar in the propensity score matched cohort (odds ratio 0.89, 95% confidence interval 0.83 to 0.97, P=0.004). A PEEP of 5 cmH2O and median plateau pressures of 16 cmH2O or less were associated with the lowest risk of postoperative respiratory complications.ConclusionsIntraoperative protective ventilation was associated with a decreased risk of postoperative respiratory complications. A PEEP of 5 cmH2O and a plateau pressure of 16 cmH2O or less were identified as protective mechanical ventilator settings. These findings suggest that protective thresholds differ for intraoperative ventilation in patients with normal lungs compared with those used for patients with acute lung injury.

Project description:The effect of alterations in tidal volume on mortality of acute respiratory distress syndrome (ARDS) is determined by respiratory system compliance. We aimed to investigate the effects of different tidal volumes on lung strain in ARDS patients who had various levels of respiratory system compliance.Nineteen patients were divided into high (Chigh group) and low (Clow group) respiratory system compliance groups based on their respiratory system compliance values. We defined compliance ?0.6 ml/(cmH2O/kg) as Chigh and compliance <0.6 ml/(cmH2O/kg) as Clow. End-expiratory lung volumes (EELV) at various tidal volumes were measured by nitrogen wash-in/washout. Lung strain was calculated as the ratio between tidal volume and EELV. The primary outcome was that lung strain is a function of tidal volume in patients with various levels of respiratory system compliance.The mean baseline EELV, strain and respiratory system compliance values were 1873 ml, 0.31 and 0.65 ml/(cmH2O/kg), respectively; differences in all of these parameters were statistically significant between the two groups. For all participants, a positive correlation was found between the respiratory system compliance and EELV (R?=?0.488, p?=?0.034). Driving pressure and strain increased together as the tidal volume increased from 6 ml/kg predicted body weight (PBW) to 12 ml/kg PBW. Compared to the Chigh ARDS patients, the driving pressure was significantly higher in the Clow patients at each tidal volume. Similar effects of lung strain were found for tidal volumes of 6 and 8 ml/kg PBW. The "lung injury" limits for driving pressure and lung strain were much easier to exceed with increases in the tidal volume in Clow patients.Respiratory system compliance affected the relationships between tidal volume and driving pressure and lung strain in ARDS patients. These results showed that increasing tidal volume induced lung injury more easily in patients with low respiratory system compliance.Clinicaltrials.gov identifier NCT01864668 , Registered 21 May 2013.

Dataset Information

Respiratory system compliance during anesthesia induction and postoperative mechanical ventilation needs: An observational study.

Background and aims

Methods

Results

Conclusion

Publications

Respiratory system compliance during anesthesia induction and postoperative mechanical ventilation needs: An observational study.

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