术中机械通气时的通气频率与术后肺部并发症：医院登记研究。
Ventilatory frequency during intraoperative mechanical ventilation and postoperative pulmonary complications: a hospital registry study.
机构信息
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Anesthesia and Critical Care, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China.
出版信息
Br J Anaesth. 2020 Jul;125(1):e130-e139. doi: 10.1016/j.bja.2020.02.018. Epub 2020 Mar 26.
BACKGROUND
High ventilatory frequencies increase static lung strain and possibly lung stress by shortening expiratory time, increasing intrathoracic pressure, and causing dynamic hyperinflation. We hypothesised that high intraoperative ventilatory frequencies were associated with postoperative respiratory complications.
METHODS
In this retrospective hospital registry study, we analysed data from adult non-cardiothoracic surgical cases performed under general anaesthesia with mechanical ventilation at a single centre between 2005 and 2017. We assessed the association between intraoperative ventilatory frequency (categorised into four groups) and postoperative respiratory complications, defined as composite of invasive mechanical ventilation within 7 days after surgery or peripheral oxygen desaturation after extubation, using multivariable logistic regression. In a subgroup, we adjusted analyses for arterial blood gas parameters.
RESULTS
A total of 102 632 cases were analysed. Intraoperative ventilatory frequencies ranged from a median (inter-quartile range [IQR]) of 8 (8-9) breaths min (Group 1) to 15 (14-18) breaths min (Group 4). High ventilatory frequencies were associated with higher odds of postoperative respiratory complications (adjusted odds ratio=1.26; 95% confidence interval, 1.14-1.38; P<0.001), which was confirmed in a subgroup after adjusting for arterial partial pressure of carbon dioxide and the ratio of arterial oxygen partial pressure to fractional inspired oxygen. We identified considerable variability in the use of high ventilatory frequencies attributable to individual provider preference (ranging from 22% to 88%) and temporal change; however, the association with postoperative respiratory complications remained unaffected.
CONCLUSIONS
High intraoperative ventilatory frequency was associated with increased risk of postoperative respiratory complications, and increased postoperative healthcare utilisation.
背景
高通气频率通过缩短呼气时间、增加胸腔内压力和导致动态过度充气来增加静态肺应变和可能的肺应力。我们假设术中高通气频率与术后呼吸并发症有关。
方法
在这项回顾性医院登记研究中，我们分析了 2005 年至 2017 年间在单一中心接受全身麻醉和机械通气的非心胸外科成人手术病例的数据。我们评估了术中通气频率（分为四组）与术后呼吸并发症之间的关联，术后呼吸并发症定义为术后 7 天内需要进行有创机械通气或拔管后外周血氧饱和度下降的复合结果，使用多变量逻辑回归进行分析。在亚组中，我们调整了血气参数分析。
结果
共分析了 102632 例病例。术中通气频率范围为中位数（四分位距[IQR]）8（8-9）次/分钟（第 1 组）至 15（14-18）次/分钟（第 4 组）。高通气频率与术后呼吸并发症的发生几率较高相关（校正比值比=1.26；95%置信区间，1.14-1.38；P<0.001），在亚组中调整动脉二氧化碳分压和动脉血氧分压与吸入氧分数比后得到了验证。我们发现，由于个体提供者偏好（22%至 88%）和时间变化，高通气频率的使用存在相当大的差异；然而，与术后呼吸并发症的关联仍然存在。
结论
术中高通气频率与术后呼吸并发症风险增加和术后医疗保健利用增加相关。
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