TY - JOUR
T1 - Ventilatory frequency during intraoperative mechanical ventilation and postoperative pulmonary complications
T2 - a hospital registry study
AU - Santer, Peter
AU - Zheng, Shengxing
AU - Hammer, Maximilian
AU - Nabel, Sarah
AU - Pannu, Ameeka
AU - Li, Yunping
AU - Ramachandran, Satya Krishna
AU - Vidal Melo, Marcos F.
AU - Eikermann, Matthias
N1 - Funding Information:
The authors acknowledge Lea Albrecht and Friederike Althoff (Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center) for making a non-author contribution by helping with data acquisition and analyses for the revision.
Publisher Copyright:
© 2020 British Journal of Anaesthesia
PY - 2020/7
Y1 - 2020/7
N2 - Background: High ventilatory frequencies increase static lung strain and possibly lung stress by shortening expiratory time, increasing intrathoracic pressure, and causing dynamic hyperinflation. We hypothesised that high intraoperative ventilatory frequencies were associated with postoperative respiratory complications. Methods: In this retrospective hospital registry study, we analysed data from adult non-cardiothoracic surgical cases performed under general anaesthesia with mechanical ventilation at a single centre between 2005 and 2017. We assessed the association between intraoperative ventilatory frequency (categorised into four groups) and postoperative respiratory complications, defined as composite of invasive mechanical ventilation within 7 days after surgery or peripheral oxygen desaturation after extubation, using multivariable logistic regression. In a subgroup, we adjusted analyses for arterial blood gas parameters. Results: A total of 102 632 cases were analysed. Intraoperative ventilatory frequencies ranged from a median (inter-quartile range [IQR]) of 8 (8–9) breaths min−1 (Group 1) to 15 (14–18) breaths min−1 (Group 4). High ventilatory frequencies were associated with higher odds of postoperative respiratory complications (adjusted odds ratio=1.26; 95% confidence interval, 1.14–1.38; P<0.001), which was confirmed in a subgroup after adjusting for arterial partial pressure of carbon dioxide and the ratio of arterial oxygen partial pressure to fractional inspired oxygen. We identified considerable variability in the use of high ventilatory frequencies attributable to individual provider preference (ranging from 22% to 88%) and temporal change; however, the association with postoperative respiratory complications remained unaffected. Conclusions: High intraoperative ventilatory frequency was associated with increased risk of postoperative respiratory complications, and increased postoperative healthcare utilisation.
AB - Background: High ventilatory frequencies increase static lung strain and possibly lung stress by shortening expiratory time, increasing intrathoracic pressure, and causing dynamic hyperinflation. We hypothesised that high intraoperative ventilatory frequencies were associated with postoperative respiratory complications. Methods: In this retrospective hospital registry study, we analysed data from adult non-cardiothoracic surgical cases performed under general anaesthesia with mechanical ventilation at a single centre between 2005 and 2017. We assessed the association between intraoperative ventilatory frequency (categorised into four groups) and postoperative respiratory complications, defined as composite of invasive mechanical ventilation within 7 days after surgery or peripheral oxygen desaturation after extubation, using multivariable logistic regression. In a subgroup, we adjusted analyses for arterial blood gas parameters. Results: A total of 102 632 cases were analysed. Intraoperative ventilatory frequencies ranged from a median (inter-quartile range [IQR]) of 8 (8–9) breaths min−1 (Group 1) to 15 (14–18) breaths min−1 (Group 4). High ventilatory frequencies were associated with higher odds of postoperative respiratory complications (adjusted odds ratio=1.26; 95% confidence interval, 1.14–1.38; P<0.001), which was confirmed in a subgroup after adjusting for arterial partial pressure of carbon dioxide and the ratio of arterial oxygen partial pressure to fractional inspired oxygen. We identified considerable variability in the use of high ventilatory frequencies attributable to individual provider preference (ranging from 22% to 88%) and temporal change; however, the association with postoperative respiratory complications remained unaffected. Conclusions: High intraoperative ventilatory frequency was associated with increased risk of postoperative respiratory complications, and increased postoperative healthcare utilisation.
KW - desaturation
KW - intraoperative mechanical ventilation
KW - perioperative care
KW - postoperative respiratory complications
KW - reintubation
KW - ventilatory frequency
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U2 - 10.1016/j.bja.2020.02.018
DO - 10.1016/j.bja.2020.02.018
M3 - Article
C2 - 32223967
AN - SCOPUS:85082471617
SN - 0007-0912
VL - 125
SP - e130-e139
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 1
ER -