Department of Anaesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
Department of Critical Care Medicine & Institute of Education and Research, Hospital Israelita Albert Einstein, São Paulo, Brazil.
BMC Anesthesiol. 2020 Jul 22;20(1):179. doi: 10.1186/s12871-020-01098-4.
Intraoperative mechanical ventilation may influence postoperative pulmonary complications (PPCs). Current practice during thoracic surgery is not well described.
This is a post-hoc analysis of the prospective multicenter cross-sectional LAS VEGAS study focusing on patients who underwent thoracic surgery. Consecutive adult patients receiving invasive ventilation during general anesthesia were included in a one-week period in 2013. Baseline characteristics, intraoperative and postoperative data were registered. PPCs were collected as composite endpoint until the 5th postoperative day. Patients were stratified into groups based on the use of one lung ventilation (OLV) or two lung ventilation (TLV), endoscopic vs. non-endoscopic approach and ARISCAT score risk for PPCs. Differences between subgroups were compared using χ or Fisher exact tests or Student's t-test. Kaplan-Meier estimates of the cumulative probability of development of PPC and hospital discharge were performed. Cox-proportional hazard models without adjustment for covariates were used to assess the effect of the subgroups on outcome.
From 10,520 patients enrolled in the LAS VEGAS study, 302 patients underwent thoracic procedures and were analyzed. There were no differences in patient characteristics between OLV vs. TLV, or endoscopic vs. open surgery. Patients received V of 7.4 ± 1.6 mL/kg, a PEEP of 3.5 ± 2.4 cmHO, and driving pressure of 14.4 ± 4.6 cmHO. Compared with TLV, patients receiving OLV had lower V and higher peak, plateau and driving pressures, higher PEEP and respiratory rate, and received more recruitment maneuvers. There was no difference in the incidence of PPCs in OLV vs. TLV or in endoscopic vs. open procedures. Patients at high risk had a higher incidence of PPCs compared with patients at low risk (48.1% vs. 28.9%; hazard ratio, 1.95; 95% CI 1.05-3.61; p = 0.033). There was no difference in the incidence of severe PPCs. The in-hospital length of stay (LOS) was longer in patients who developed PPCs. Patients undergoing OLV, endoscopic procedures and at low risk for PPC had shorter LOS.
PPCs occurred frequently and prolonged hospital LOS following thoracic surgery. Proportionally large tidal volumes and high driving pressure were commonly used in this sub-population. However, large RCTs are needed to confirm these findings.
This trial was prospectively registered at the Clinical Trial Register (www.clinicaltrials.gov; NCT01601223 ; registered May 17, 2012.).
术中机械通气可能会影响术后肺部并发症（PPCs）。目前胸外科的实践情况尚不清楚。
这是对前瞻性多中心 LAS VEGAS 研究的事后分析，该研究主要关注接受胸外科手术的患者。2013 年一周内连续纳入接受全身麻醉下有创通气的成年患者。记录基线特征、术中及术后数据。将 PPCs 作为复合终点，直至术后第 5 天。根据使用单肺通气（OLV）或双肺通气（TLV）、内镜与非内镜方法以及 ARISCAT 评分的 PPC 风险，将患者分为不同组。使用 χ 或 Fisher 确切检验或 Student t 检验比较亚组之间的差异。使用 Kaplan-Meier 估计累积 PPC 发生率和住院出院概率。未调整协变量的 Cox 比例风险模型用于评估亚组对结果的影响。
在 LAS VEGAS 研究中，纳入了 10520 名患者，其中 302 名患者接受了胸科手术并进行了分析。OLV 与 TLV 之间、内镜与开放手术之间的患者特征无差异。患者接受了 7.4±1.6mL/kg 的潮气量、3.5±2.4cmHO 的 PEEP、14.4±4.6cmHO 的驱动压。与 TLV 相比，接受 OLV 的患者潮气量更低，峰压、平台压和驱动压更高，PEEP 和呼吸频率更高，并且接受更多的复张手法。OLV 与 TLV 或内镜与开放手术之间 PPCs 的发生率无差异。高危患者的 PPCs 发生率高于低危患者（48.1%比 28.9%；危险比，1.95；95%CI，1.05-3.61；p=0.033）。严重 PPCs 的发生率无差异。发生 PPCs 的患者住院时间（LOS）较长。接受 OLV、内镜手术和 PPCs 低危的患者 LOS 更短。
胸外科手术后 PPCs 发生率高，住院时间延长。该亚人群中，常使用较大的潮气量和较高的驱动压。但是，需要进行大规模 RCT 来证实这些发现。
该试验前瞻性地在临床试验注册处（www.clinicaltrials.gov；NCT01601223；注册于 2012 年 5 月 17 日）注册。
