• Chiara Robba, HemmesSabrine N TSNTDepartment of Intensive Care, Amsterdam University Medical Centers, location 'AMC', Amsterdam, The Netherlands.Department of Anaesthesiology, Amsterdam University Medical Centers, location 'AMC', Amsterdam, The Netherlands., Ary Serpa Neto, Thomas Bluth, Jaume Canet, Michael Hiesmayr, M Wiersma Hollmann, Gary H Mills, Vidal MeloMarcos FMFDepartment of Anaesthesia, Critical Care and Pain Medicine, Massachussetts General Hospital, Boston, MA, USA., Christian Putensen, Samir Jaber, Werner Schmid, Paolo Severgnini, Hermann Wrigge, Denise Battaglini, Lorenzo Ball, Gama de AbreuMarceloMDepartment of Anaesthesiology and Intensive Care Medicine, Pulmonary engineering group, University Hospital Carl Gustav Carus, Technische Universitat Dresden, Dresden, Germany., Marcus J Schultz, Paolo Pelosi, FERS for the LAS VEGAS investigators, and PROtective VEntilation Network and the Clinical Trial Network of the European Society of Anaesthesiology.
• Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Largo Rosanna Benzi 8, 16131, Genoa, Italy. kiarobba@gmail.com.
• BMC Anesthesiol. 2020 Apr 2; 20 (1): 73.

BackgroundLimited information is available regarding intraoperative ventilator settings and the incidence of postoperative pulmonary complications (PPCs) in patients undergoing neurosurgical procedures. The aim of this post-hoc analysis of the 'Multicentre Local ASsessment of VEntilatory management during General Anaesthesia for Surgery' (LAS VEGAS) study was to examine the ventilator settings of patients undergoing neurosurgical procedures, and to explore the association between perioperative variables and the development of PPCs in neurosurgical patients.MethodsPost-hoc analysis of LAS VEGAS study, restricted to patients undergoing neurosurgery. Patients were stratified into groups based on the type of surgery (brain and spine), the occurrence of PPCs and the assess respiratory risk in surgical patients in Catalonia (ARISCAT) score risk for PPCs.ResultsSeven hundred eighty-four patients were included in the analysis; 408 patients (52%) underwent spine surgery and 376 patients (48%) brain surgery. Median tidal volume (VT) was 8 ml [Interquartile Range, IQR = 7.3-9] per predicted body weight; median positive end-expiratory pressure (PEEP) was 5 [3 to 5] cmH20. Planned recruitment manoeuvres were used in the 6.9% of patients. No differences in ventilator settings were found among the sub-groups. PPCs occurred in 81 patients (10.3%). Duration of anaesthesia (odds ratio, 1.295 [95% confidence interval 1.067 to 1.572]; p = 0.009) and higher age for the brain group (odds ratio, 0.000 [0.000 to 0.189]; p = 0.031), but not intraoperative ventilator settings were independently associated with development of PPCs.ConclusionsNeurosurgical patients are ventilated with low VT and low PEEP, while recruitment manoeuvres are seldom applied. Intraoperative ventilator settings are not associated with PPCs.

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