• Dharshi Karalapillai, Laurence Weinberg, NetoAry SerpaASDepartment of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia.Australian and New Zealand Intensive Care Research Centre, School of Public Health , Philip J Peyton, Louise Ellard, Raymond Hu, Brett Pearce, Chong Tan, David Story, Mark O'Donnell, Patrick Hamilton, Chad Oughton, Jonathan Galtieri, Sree Appu, Anthony Wilson, Glenn Eastwood, Rinaldo Bellomo, and Daryl A Jones.
• Department of Anaesthesia, Austin Hospital, Melbourne, VIC, Australia. dharshi.karalapillai@austin.org.au.
• BMC Anesthesiol. 2022 May 16; 22 (1): 149149.

BackgroundLow tidal volume (VT) ventilation and its associated increase in arterial carbon dioxide (PaCO2) may affect postoperative neurologic function. We aimed to test the hypothesis that intraoperative low VT ventilation affect the incidence of postoperative ICD-10 coded delirium and/or the need for antipsychotic medications.MethodsThis is a post-hoc analysis of a large randomized controlled trial evaluating low vs. conventional VT ventilation during major non-cardiothoracic, non-intracranial surgery. The primary outcome was the incidence of ICD-10 delirium and/or the use of antipsychotic medications during hospital stay, and the absolute difference with its 95% confidence interval (CI) was calculated.ResultsWe studied 1206 patients (median age of 64 [55-72] years, 59.0% males, median ARISCAT of 26 [19-37], and 47.6% of ASA 3). ICD-10 coded delirium and /or antipsychotic medication use was diagnosed in 11.2% with similar incidence between low and conventional VT ventilation (11.1% vs. 11.3%; absolute difference, -0.24 [95%CI, -3.82 to 3.32]; p = 0.894). There was no interaction between allocation group and type of surgery.ConclusionIn adult patients undergoing major surgery, low VT ventilation was not associated with increased risk of ICD-10 delirium and/or the use of antipsychotic medications during hospital stay.Trial RegistrationANZCTR Identifier: ACTRN12614000790640 .© 2022. The Author(s).

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