The association of postoperative pulmonary complications in 109,360 patients with pressure‐controlled or volume‐controlled ventilation |
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| Authors: | A. Bagchi M. I. Rudolph P. Y. Ng F. P. Timm D. R. Long S. Shaefi K. Ladha M. F. Vidal Melo M. Eikermann |
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| Affiliation: | 1. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA;2. Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA;3. Department of Anesthesia and Pain Medicine, University of Toronto and Toronto General Hospital, Toronto, ON, Canada;4. Klinik für An?sthesiologie und Intensivmedizin, Universit?t Duisburg‐Essen, Essen, Germany |
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| Abstract: | We thought that the rate of postoperative pulmonary complications might be higher after pressure‐controlled ventilation than after volume‐controlled ventilation. We analysed peri‐operative data recorded for 109,360 adults, whose lungs were mechanically ventilated during surgery at three hospitals in Massachusetts, USA. We used multivariable regression and propensity score matching. Postoperative pulmonary complications were more common after pressure‐controlled ventilation, odds ratio (95%CI) 1.29 (1.21–1.37), p < 0.001. Tidal volumes and driving pressures were more varied with pressure‐controlled ventilation compared with volume‐controlled ventilation: mean (SD) variance from the median 1.61 (1.36) ml.kg?1 vs. 1.23 (1.11) ml.kg?1, p < 0.001; and 3.91 (3.47) cmH2O vs. 3.40 (2.69) cmH2O, p < 0.001. The odds ratio (95%CI) of pulmonary complications after pressure‐controlled ventilation compared with volume‐controlled ventilation at positive end‐expiratory pressures < 5 cmH2O was 1.40 (1.26–1.55) and 1.20 (1.11–1.31) when ≥ 5 cmH2O, both p < 0.001, a relative risk ratio of 1.17 (1.03–1.33), p = 0.023. The odds ratio (95%CI) of pulmonary complications after pressure‐controlled ventilation compared with volume‐controlled ventilation at driving pressures of < 19 cmH2O was 1.37 (1.27–1.48), p < 0.001, and 1.16 (1.04–1.30) when ≥ 19 cmH2O, p = 0.011, a relative risk ratio of 1.18 (1.07–1.30), p = 0.016. Our data support volume‐controlled ventilation during surgery, particularly for patients more likely to suffer postoperative pulmonary complications. |
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| Keywords: | lung protection ventilation: pressure goal pressure‐controlled ventilation volume‐controlled ventilation |
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