Airway driving pressure is associated with postoperative pulmonary complications after major abdominal surgery: a multicentre retrospective observational cohort study
Nicholas J. Douville,
Timothy L. McMurry,
Jennie Z. Ma,
Bhiken I. Naik,
Michael R. Mathis,
DouglasA. Colquhoun,
Sachin Kheterpal,
Nathan L. Pace,
Traci L. Hedrick,
Randal S. Blank,
Marcel E. Durieux,
Stephen Patrick Bender,
Stefan D. Holubar
Affiliations
Nicholas J. Douville
Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI, USA; Institute of Healthcare Policy & Innovation and; Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
Timothy L. McMurry
Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA
Jennie Z. Ma
Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA
Bhiken I. Naik
Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA
Michael R. Mathis
Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI, USA; Institute of Healthcare Policy & Innovation and; Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
DouglasA. Colquhoun
Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI, USA; Institute of Healthcare Policy & Innovation and
Sachin Kheterpal
Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI, USA; Institute of Healthcare Policy & Innovation and
Nathan L. Pace
Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
Traci L. Hedrick
Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
Randal S. Blank
Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA; Corresponding author.
Marcel E. Durieux
Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA
Stephen Patrick Bender
Department of Anesthesiology and Critical Care Medicine, University of Vermont Medical Center, Burlington, VT, USA
Stefan D. Holubar
Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
Background: High airway driving pressure is associated with adverse outcomes in critically ill patients receiving mechanical ventilation, but large multicentre studies investigating airway driving pressure during major surgery are lacking. We hypothesised that increased driving pressure is associated with postoperative pulmonary complications in patients undergoing major abdominal surgery. Methods: In this preregistered multicentre retrospective observational cohort study, the authors reviewed major abdominal surgical procedures in 11 hospitals from 2004 to 2018. The primary outcome was a composite of postoperative pulmonary complications, defined as postoperative pneumonia, unplanned tracheal intubation, or prolonged mechanical ventilation for more than 48 h. Associations between intraoperative dynamic driving pressure and outcomes, adjusted for patient and procedural factors, were evaluated. Results: Among 14 218 qualifying cases, 389 (2.7%) experienced postoperative pulmonary complications. After adjustment, the mean dynamic driving pressure was associated with postoperative pulmonary complications (adjusted odds ratio for every 1 cm H2O increase: 1.04; 95% confidence interval [CI], 1.02–1.06; P<0.001). Neither tidal volume nor PEEP was associated with postoperative pulmonary complications. Increased BMI, shorter height, and female sex were predictors for higher dynamic driving pressure (β=0.35, 95% CI 0.32–0.39, P<0.001; β=–0.01, 95% CI –0.02 to 0.00, P=0.005; and β=0.74, 95% CI 0.63–0.86, P<0.001, respectively). Conclusions: Dynamic airway driving pressure, but not tidal volume or PEEP, is associated with postoperative pulmonary complications in models controlling for a large number of risk predictors and covariates. Such models are capable of risk prediction applicable to individual patients.
