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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

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25.01.2023 | Reports of Original Investigations

The association of intraoperative low driving pressure ventilation and nonhome discharge: a historical cohort study

verfasst von: Tim M. Tartler, cand. med., Luca J. Wachtendorf, cand. med., Aiman Suleiman, MD, MSc, Michael Blank, cand. med., Elena Ahrens, cand. med., Felix C. Linhardt, cand. med., Friederike C. Althoff, MD, Guanqing Chen, PhD, Peter Santer, MD, DPhil, Alexander Nagrebetsky, MD, MSc, Matthias Eikermann, MD, PhD, Maximilian S. Schaefer, MD, PhD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 3/2023

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Abstract

Purpose

To evaluate whether intraoperative ventilation using lower driving pressure decreases the risk of nonhome discharge.

Methods

We conducted a historical cohort study of patients aged ≥ 60 yr who were living at home before undergoing elective, noncardiothoracic surgery at two tertiary healthcare networks in Massachusetts between 2007 and 2018. We assessed the association of the median driving pressure during intraoperative mechanical ventilation with nonhome discharge using multivariable logistic regression analysis, adjusted for patient and procedural factors. Contingent on the primary association, we assessed effect modification by patients’ baseline risk and mediation by postoperative respiratory failure.

Results

Of 87,407 included patients, 12,584 (14.4%) experienced nonhome discharge. In adjusted analyses, a lower driving pressure was associated with a lower risk of nonhome discharge (adjusted odds ratio [aOR], 0.88; 95% confidence interval [CI], 0.83 to 0.93, per 10 cm H₂O decrease; P < 0.001). This association was magnified in patients with a high baseline risk (aOR, 0.77; 95% CI, 0.73 to 0.81, per 10 cm H₂O decrease, P-for-interaction < 0.001). The findings were confirmed in 19,518 patients matched for their baseline respiratory system compliance (aOR, 0.90; 95% CI, 0.81 to 1.00; P = 0.04 for low [< 15 cm H₂O] vs high [≥ 15 cm H₂O] driving pressures). A lower risk of respiratory failure mediated the association of a low driving pressure with nonhome discharge (20.8%; 95% CI, 15.0 to 56.8; P < 0.001).

Conclusions

Intraoperative ventilation maintaining lower driving pressure was associated with a lower risk of nonhome discharge, which can be partially explained by lowered rates of postoperative respiratory failure. Future randomized controlled trials should target driving pressure as a potential intervention to decrease nonhome discharge.

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Titel: The association of intraoperative low driving pressure ventilation and nonhome discharge: a historical cohort study
verfasst von: Tim M. Tartler, cand. med.
Luca J. Wachtendorf, cand. med.
Aiman Suleiman, MD, MSc
Michael Blank, cand. med.
Elena Ahrens, cand. med.
Felix C. Linhardt, cand. med.
Friederike C. Althoff, MD
Guanqing Chen, PhD
Peter Santer, MD, DPhil
Alexander Nagrebetsky, MD, MSc
Matthias Eikermann, MD, PhD
Maximilian S. Schaefer, MD, PhD
Publikationsdatum: 25.01.2023
Verlag: Springer International Publishing
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 3/2023
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-022-02378-y

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The association of intraoperative low driving pressure ventilation and nonhome discharge: a historical cohort study

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Methods

Results

Conclusions

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