Intra-operative ventilator mechanical power as a predictor of postoperative pulmonary complications in surgical patients: A secondary analysis of a randomised clinical trial

Dharshi Karalapillai, Laurence Weinberg, Serpa Neto A, Philip Peyton, Louise Ellard, Raymond Hu, Brett Pearce, Chong O Tan, David Story, Mark O'Donnell, Patrick Hamilton, Chad Oughton, Jonathan Galtieri, Anthony Wilson, Glenn Eastwood, Rinaldo Bellomo, Daryl A Jones, Dharshi Karalapillai, Laurence Weinberg, Serpa Neto A, Philip Peyton, Louise Ellard, Raymond Hu, Brett Pearce, Chong O Tan, David Story, Mark O'Donnell, Patrick Hamilton, Chad Oughton, Jonathan Galtieri, Anthony Wilson, Glenn Eastwood, Rinaldo Bellomo, Daryl A Jones

Abstract

Background: Studies in critically ill patients suggest a relationship between mechanical power (an index of the energy delivered by the ventilator, which includes driving pressure, respiratory rate, tidal volume and inspiratory pressure) and complications.

Objective: We aimed to assess the association between intra-operative mechanical power and postoperative pulmonary complications (PPCs).

Design: Post hoc analysis of a large randomised clinical trial.

Setting: University-affiliated academic tertiary hospital in Melbourne, Australia, from February 2015 to February 2019.

Patients: Adult patients undergoing major noncardiothoracic, nonintracranial surgery.

Intervention: Dynamic mechanical power was calculated using the power equation adjusted by the respiratory system compliance (CRS). Multivariable models were used to assess the independent association between mechanical power and outcomes.

Main outcome measures: The primary outcome was the incidence of PPCs within the first seven postoperative days. The secondary outcome was the incidence of acute respiratory failure.

Results: We studied 1156 patients (median age [IQR]: 64 [55 to 72] years, 59.5% men). Median mechanical power adjusted by CRS was 0.32 [0.22 to 0.51] (J min-1)/(ml cmH2O-1). A higher mechanical power was also independently associated with increased risk of PPCs [odds ratio (OR 1.34, 95% CI, 1.17 to 1.52); P < 0.001) and acute respiratory failure (OR 1.40, 95% CI, 1.21 to 1.61; P < 0.001).

Conclusion: In patients receiving ventilation during major noncardiothoracic, nonintracranial surgery, exposure to a higher mechanical power was independently associated with an increased risk of PPCs and acute respiratory failure.

Trial registration: Australia and New Zealand Clinical Trials Registry no: 12614000790640.

Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology and Intensive Care.

Figures

Fig. 1
Fig. 1
Flow chart.
Fig. 2
Fig. 2
Odds ratio for postoperative pulmonary complications and acute respiratory failure.

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Source: PubMed

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