Objectives To determine whether driving pressure and expiratory flow limitation are associated with the development of postoperative pulmonary complications (PPCs) in cardiac surgery patients. Design Prospective cohort study. Setting University Hospital San Raffaele, Milan, Italy. Participants Patients undergoing elective cardiac surgery. Measurements and Main Results The primary endpoint was the occurrence of a predefined composite of PPCs. The authors determined the association among PPCs and intraoperative ventilation parameters, mechanical power and energy load, and occurrence of expiratory flow limitation (EFL) assessed with the positive end-expiratory pressure test. Two hundred patients were enrolled, of whom 78 (39%) developed one or more PPCs. Patients with PPCs, compared with those without PPCs, had similar driving pressure (mean difference [MD] –0.1 [95% confidence interval (CI), –1.0 to 0.7] cmH2O, p = 0.561), mechanical power (MD 0.5 [95% CI, –0.3 to 1.1] J/m, p = 0.364), and total energy load (MD 95 [95% CI, –78 to 263] J, p = 0.293), but they had a higher incidence of EFL (51% v 38%, p = 0.005). Only EFL was associated independently with the development of PPCs (odds ratio 2.46 [95% CI, 1.28-4.80], p = 0.007). Conclusions PPCs occurred frequently in this patient population undergoing cardiac surgery. PPCs were associated independently with the presence of EFL but not with driving pressure, total energy load, or mechanical power.

Associations Between Expiratory Flow Limitation and Postoperative Pulmonary Complications in Patients Undergoing Cardiac Surgery

Volta CA
Secondo
;
Spadaro S;Pelosi P
Penultimo
;
2022

Abstract

Objectives To determine whether driving pressure and expiratory flow limitation are associated with the development of postoperative pulmonary complications (PPCs) in cardiac surgery patients. Design Prospective cohort study. Setting University Hospital San Raffaele, Milan, Italy. Participants Patients undergoing elective cardiac surgery. Measurements and Main Results The primary endpoint was the occurrence of a predefined composite of PPCs. The authors determined the association among PPCs and intraoperative ventilation parameters, mechanical power and energy load, and occurrence of expiratory flow limitation (EFL) assessed with the positive end-expiratory pressure test. Two hundred patients were enrolled, of whom 78 (39%) developed one or more PPCs. Patients with PPCs, compared with those without PPCs, had similar driving pressure (mean difference [MD] –0.1 [95% confidence interval (CI), –1.0 to 0.7] cmH2O, p = 0.561), mechanical power (MD 0.5 [95% CI, –0.3 to 1.1] J/m, p = 0.364), and total energy load (MD 95 [95% CI, –78 to 263] J, p = 0.293), but they had a higher incidence of EFL (51% v 38%, p = 0.005). Only EFL was associated independently with the development of PPCs (odds ratio 2.46 [95% CI, 1.28-4.80], p = 0.007). Conclusions PPCs occurred frequently in this patient population undergoing cardiac surgery. PPCs were associated independently with the presence of EFL but not with driving pressure, total energy load, or mechanical power.
2022
Ball, L; Volta, Ca; Saglietti, F; Spadaro, S; Di Lullo, A; De Simone, G; Guarnieri, M; Della Corte, F; Serpa Neto, A; Gama de Abreu, M; Schultz, Mj; Zangrillo, A; Pelosi, P; Bignami, E.
File in questo prodotto:
File Dimensione Formato  
1-s2.0-S1053077021006169-main.pdf

solo gestori archivio

Descrizione: Article in press
Tipologia: Full text (versione editoriale)
Licenza: NON PUBBLICO - Accesso privato/ristretto
Dimensione 841.61 kB
Formato Adobe PDF
841.61 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
1-s2.0-S1053077021006169-main.pdf

solo gestori archivio

Descrizione: Full text editoriale
Tipologia: Full text (versione editoriale)
Licenza: NON PUBBLICO - Accesso privato/ristretto
Dimensione 876.48 kB
Formato Adobe PDF
876.48 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/2470349
Citazioni
  • ???jsp.display-item.citation.pmc??? 1
  • Scopus 4
  • ???jsp.display-item.citation.isi??? 3
social impact