February 2019

Article: Driving Pressure during Thoracic Surgery: A Randomized Clinical Trial

URLhttp://anesthesiology.pubs.asahq.org/article.aspx?articleid=2722706

DOI: doi:10.1097/ALN.0000000000002600

Published: Anesthesiology 2019; 130: 385- 393

Authors:Mi Hye Park, Hyun Joo Ahn, Jie Ae Kim, Mikyung Yang, Burn Young Heo, Ji Won Choi, Yung Ri Kim, Sang Hyun Lee, HeeJoon Jeong, Soo Joo Choi, In Sun Song.

Article Description:

This is a randomized clinical trial that investigates the effects of driving pressure-guided ventilation during thoracic surgeries on the postoperative respiratory complications.

This interesting article has been published under the perioperative medicine section of Anesthesiology journal.

Summary

  • Ventilator induced lung injury during one lung ventilation in the form of volutrauma, atelectrauma and barotrauma might be associated with a high incidence of postoperative pulmonary complications (PPC).
  • Driving pressure, defined as the difference between the plateau and end-expiratory airway pressure (PEEP), has not been reported during one lung ventilation for thoracic anesthesia where isolated, inflated lungs may be especially at risk.
  • High driving pressure has been proposed to be associated with more respiratory complications rather than the direct effects of PEEP or plateau pressure.
  • In this article, the investigators randomised 292 patients scheduled for elective thoracic surgery to ventilate the non-surgical lung with conventional lung ventilation strategy or a driving pressure-guided ventilation. The primary outcome was the incidence of PPC according to Melbourne group scale (at least 4) till the third postoperative day.
  • The results were, interestingly, supporting the idea of the protective effects of the driving pressure-guided ventilation during the one-lung ventilation. The incidence of PPC was reported 5.5 % in the driving pressure group vs 12.2% in the conventional ventilation group (P = 0.047, odds ratio 0.42; 95% CI, 0.18 to 0.99).
  • The investigators concluded that driving pressure–guided ventilation during one-lung ventilation was related to a reduced incidence of postoperative pulmonary complications compared with conventional protective ventilation in thoracic surgery.
  • Application of the patient’s specific PEEP, which can reduce driving pressure, may be recommended for thoracic surgery patients.

Tell us; In your practice, would you individualise PEEP to achieve the lowest driving pressure during one-lung ventilation?

Excitedly, waiting for your valuable discussion and comments.

Summary slide:

Source - please click here

Share your experience with us and take part into the polls:

Poll 1A - Do you use any routine measures for the prevention of postoperative atrial fibrillation following cardiac surgery?

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Poll 1B - One of the limitations of that interesting study is the none measurement of intrinsic PEEP would might impact the measurement of the Driving Pressures. Are you routinely measuring intrinsic PEEP during one lung ventilation?

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Poll 2 - Amiodarone should be considered for prevention of AF after cardiac surgery. Would you adopt this practice?

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