TY - JOUR
T1 - Association between intraoperative tidal volume and postoperative respiratory complications is dependent on respiratory elastance
T2 - a retrospective, multicentre cohort study
AU - Suleiman, Aiman
AU - Costa, Eduardo
AU - Santer, Peter
AU - Tartler, Tim M.
AU - Wachtendorf, Luca J.
AU - Teja, Bijan
AU - Chen, Guanqing
AU - Baedorf-Kassis, Elias
AU - Nagrebetsky, Alexander
AU - Vidal Melo, Marcos F.
AU - Eikermann, Matthias
AU - Schaefer, Maximilian S.
N1 - Funding Information:
MSS has received grants for investigator-initiated studies from Merck & Co. EC reports personal fees from Timpel and personal fees from Mag-named, outside the submitted work. ME has received grants for investigator-initiated trials not related to this manuscript from Merck & Co. and served as a consultant in the advisory board of Merck & Co. during the conduct of the study. EB-K received funding from Hamilton Medical Inc.
Funding Information:
Institutional funding from the Department of Anesthesia, Critical Care & Pain Medicine at Beth Israel Deaconess Medical Center (Boston, MA, USA). Unrestricted grant from Jeffrey and Judy Buzen (to ME).
Publisher Copyright:
© 2022 British Journal of Anaesthesia
PY - 2022/8
Y1 - 2022/8
N2 - Background: The impact of high vs low intraoperative tidal volumes on postoperative respiratory complications remains unclear. We hypothesised that the effect of intraoperative tidal volume on postoperative respiratory complications is dependent on respiratory system elastance. Methods: We retrospectively recorded tidal volume (Vt; ml kg−1 ideal body weight [IBW]) in patients undergoing elective, non-cardiothoracic surgery from hospital registry data. The primary outcome was respiratory failure (requiring reintubation within 7 days of surgery, desaturation after extubation, or both). The primary exposure was defined as the interaction between Vt and standardised respiratory system elastance (driving pressure divided by Vt; cm H2O/[ml kg−1]). Multivariable logistic regression models, with and without interaction terms (which categorised Vt as low [Vt ≤8 ml kg−1] or high [Vt >8 ml kg−1]), were adjusted for potential confounders. Additional analyses included path mediation analysis and fractional polynomial modelling. Results: Overall, 10 821/197 474 (5.5%) patients sustained postoperative respiratory complications. Higher Vt was associated with greater risk of postoperative respiratory complications (adjusted odds ratio=1.42 per ml kg−1; 95% confidence interval [CI], 1.35–1.50]; P<0.001). This association was modified by respiratory system elastance (P<0.001); in patients with low compliance (<42.4 ml cm H2O−1), higher Vt was associated with greater risk of postoperative respiratory complications (adjusted risk difference=0.3% [95% CI, 0.0–0.5] at 41.2 ml cm H2O−1 compliance, compared with 5.8% [95% CI, 3.8–7.8] at 14 ml cm H2O−1 compliance). This association was absent when compliance exceeded 41.2 ml cm H2O−1. Adverse effects associated with high Vt were entirely mediated by driving pressures (P<0.001). Conclusions: The association of harm with higher tidal volumes during intraoperative mechanical ventilation is modified by respiratory system elastance. These data suggest that respiratory elastance should inform the design of perioperative trials testing intraoperative ventilatory strategies.
AB - Background: The impact of high vs low intraoperative tidal volumes on postoperative respiratory complications remains unclear. We hypothesised that the effect of intraoperative tidal volume on postoperative respiratory complications is dependent on respiratory system elastance. Methods: We retrospectively recorded tidal volume (Vt; ml kg−1 ideal body weight [IBW]) in patients undergoing elective, non-cardiothoracic surgery from hospital registry data. The primary outcome was respiratory failure (requiring reintubation within 7 days of surgery, desaturation after extubation, or both). The primary exposure was defined as the interaction between Vt and standardised respiratory system elastance (driving pressure divided by Vt; cm H2O/[ml kg−1]). Multivariable logistic regression models, with and without interaction terms (which categorised Vt as low [Vt ≤8 ml kg−1] or high [Vt >8 ml kg−1]), were adjusted for potential confounders. Additional analyses included path mediation analysis and fractional polynomial modelling. Results: Overall, 10 821/197 474 (5.5%) patients sustained postoperative respiratory complications. Higher Vt was associated with greater risk of postoperative respiratory complications (adjusted odds ratio=1.42 per ml kg−1; 95% confidence interval [CI], 1.35–1.50]; P<0.001). This association was modified by respiratory system elastance (P<0.001); in patients with low compliance (<42.4 ml cm H2O−1), higher Vt was associated with greater risk of postoperative respiratory complications (adjusted risk difference=0.3% [95% CI, 0.0–0.5] at 41.2 ml cm H2O−1 compliance, compared with 5.8% [95% CI, 3.8–7.8] at 14 ml cm H2O−1 compliance). This association was absent when compliance exceeded 41.2 ml cm H2O−1. Adverse effects associated with high Vt were entirely mediated by driving pressures (P<0.001). Conclusions: The association of harm with higher tidal volumes during intraoperative mechanical ventilation is modified by respiratory system elastance. These data suggest that respiratory elastance should inform the design of perioperative trials testing intraoperative ventilatory strategies.
KW - driving pressure
KW - lung protective ventilation
KW - mechanical ventilation
KW - postoperative pulmonary complications
KW - respiratory system elastance
KW - tidal volume
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U2 - 10.1016/j.bja.2022.05.005
DO - 10.1016/j.bja.2022.05.005
M3 - Article
C2 - 35690489
AN - SCOPUS:85131809488
SN - 0007-0912
VL - 129
SP - 263
EP - 272
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 2
ER -