• MiHye Park, Susie Yoon, Jae-Sik Nam, Hyun Joo Ahn, Heezoo Kim, Hye Jin Kim, Hoon Choi, Hong Kwan Kim, Randal S Blank, Sung-Cheol Yun, LeeDong KyuDKDepartment of Anaesthesiology and Pain Medicine, Dongguk University Hospital, Goyang-si, South Korea., Mikyung Yang, Jie Ae Kim, Insun Song, Bo Rim Kim, BahkJae-HyonJHDepartment of Anaesthesiology and Pain Medicine, Seoul National University Hospital, University of Seoul National College of Medicine, Seoul, South Korea., Juyoun Kim, Sangho Lee, In-Cheol Choi, Young Jun Oh, Wonjung Hwang, Byung Gun Lim, and Burn Young Heo.
• Department of Anaesthesiology and Pain Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea.
• Br J Anaesth. 2023 Jan 1; 130 (1): e106e118e106-e118.

BackgroundAirway driving pressure, easily measured as plateau pressure minus PEEP, is a surrogate for alveolar stress and strain. However, the effect of its targeted reduction remains unclear.MethodsIn this multicentre trial, patients undergoing lung resection surgery were randomised to either a driving pressure group (n=650) receiving an alveolar recruitment/individualised PEEP to deliver the lowest driving pressure or to a conventional protective ventilation group (n=650) with fixed PEEP of 5 cm H2O. The primary outcome was a composite of pulmonary complications within 7 days postoperatively.ResultsThe modified intention-to-treat analysis included 1170 patients (mean [standard deviation, sd]; age, 63 [10] yr; 47% female). The mean driving pressure was 7.1 cm H2O in the driving pressure group vs 9.2 cm H2O in the protective ventilation group (mean difference [95% confidence interval, CI]; -2.1 [-2.4 to -1.9] cm H2O; P<0.001). The incidence of pulmonary complications was not different between the two groups: driving pressure group (233/576, 40.5%) vs protective ventilation group (254/594, 42.8%) (risk difference -2.3%; 95% CI, -8.0% to 3.3%; P=0.42). Intraoperatively, lung compliance (mean [sd], 42.7 [12.4] vs 33.5 [11.1] ml cm H2O-1; P<0.001) and Pao2 (median [inter-quartile range], 21.5 [14.5 to 30.4] vs 19.5 [13.5 to 29.1] kPa; P=0.03) were higher and the need for rescue ventilation was less frequent (6.8% vs 10.8%; P=0.02) in the driving pressure group.ConclusionsIn lung resection surgery, a driving pressure-guided ventilation improved pulmonary mechanics intraoperatively, but did not reduce the incidence of postoperative pulmonary complications compared with a conventional protective ventilation.Clinical Trial RegistrationNCT04260451.Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.

18 keywords...

hide…