• Change Zhu, Rufang Zhang, Jia Li, Lulu Ren, Zhiqing Gu, Rong Wei, and Mazhong Zhang.
• From the Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai (CZ, MZ), Department of Anesthesiology, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai (LR, ZG, RW), Cardiothoracic Surgery Department, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (RZ, JL).
• Eur J Anaesthesiol. 2025 Jan 1; 42 (1): 647264-72.

BackgroundPrevious studies have discussed the correlation between mechanical power (MP) and lung injury. However, evidence regarding the relationship between MP and postoperative pulmonary complications (PPCs) in children remains limited, specifically during one-lung ventilation (OLV).ObjectivesPropensity score matching was employed to generate low MP and high MP groups to verify the relationship between MP and PPCs. Multivariable logistic regression was performed to identify risk factors of PPCs in young children undergoing video-assisted thoracic surgery (VATS).DesignA retrospective study.SettingSingle-site tertiary children's hospital.PatientsChildren aged ≤2 years who underwent VATS between January 2018 and February 2023.InterventionsNone.Main Outcome MeasuresThe incidence of PPCs.ResultsOverall, 581 (median age, 6 months [interquartile range: 5-9.24 months]) children were enrolled. The median [interquartile range] MP during OLV were 2.17 [1.84 to 2.64) J min-1. One hundred and nine (18.76%) children developed PPCs. MP decreased modestly during the study period (2.63 to 1.99 J min-1; P < 0.0001). In the propensity score matched cohort for MP (221 matched pairs), MP (median MP 2.63 vs. 1.84 J min-1) was not associated with a reduction in PPCs (adjusted odds ratio, 1.43; 95% CI, 0.87 to 2.37; P = 0.16). In the propensity score matched cohort for dynamic components of MP (139 matched pairs), dynamic components (mean 2.848 vs. 4.162 J min-1) was not associated with a reduction in PPCs (adjusted odds ratio, 1.62; 95% CI, 0.85 to 3.10; P  = 0.15).The multiple logistic analysis revealed PPCs within 7 days of surgery were associated with male gender, OLV duration >90 min, less surgeon's experience and lower positive end-expiratory pressure (PEEP) value.ConclusionsMP and dynamic components were not associated with PPCs in young children undergoing VATS, whereas PPCs were associated with male gender, OLV duration >90 min, less surgeon's experience and lower PEEP value.Trial RegistrationChiCTR2300074649.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology and Intensive Care.

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