Department of Intensive Care, Amsterdam UMC, location Academic Medical Center, Amsterdam, the Netherlands.
General Intensive Care Unit, Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, Jerusalem, Israel.
Pulmonology. 2022 Mar-Apr;28(2):90-98. doi: 10.1016/j.pulmoe.2021.10.004. Epub 2021 Dec 11.
Information about epidemiology, ventilation management and outcome in postoperative intensive care unit (ICU) patients remains scarce. The objective was to test whether postoperative ventilation differs from that in the operation room.
This was a substudy of the worldwide observational LAS VEGAS study, including patients undergoing non-thoracic surgeries. Of 146 study sites participating in the LAS VEGAS study, 117 (80%) sites reported on the postoperative ICU course, including ventilation and complications. The coprimary outcomes were two key elements of ventilator management, i.e., tidal volume (V) and positive end-expiratory pressure (PEEP). Secondary outcomes included the proportion of patients receiving low V ventilation (LTVV, defined as ventilation with a median V < 8.0 ml/kg PBW), and the proportion of patients developing postoperative pulmonary complications (PPC), including ARDS, pneumothorax, pneumonia and need for escalation of ventilatory support, ICU and hospital length of stay, and mortality at day 28.
Of 653 patients who were admitted to the ICU after surgery, 274 (42%) patients received invasive postoperative ventilation. Median postoperative V was 8.4 [7.3-9.8] ml/kg predicted body weight (PBW), PEEP was 5 [5-5] cm HO, statistically significant but not meaningfully different from median intraoperative V (8.1 [7.3-8.9] ml/kg PBW; P < 0.001) and PEEP (4 [2-5] cm HO; P < 0.001). The proportion of patients receiving LTVV after surgery was 41%. The PPC rate was 10%. Length of stay in ICU and hospital was independent of development of a PPC, but hospital mortality was higher in patients who developed a PPC (24 versus 4%; P < 0.001).
In this observational study of patients undergoing non-thoracic surgeries, postoperative ventilation was not meaningfully different from that in the operating room. Like in the operating room, there is room for improved use of LTVV. Development of PPC is associated with mortality.
有关术后重症监护病房（ICU）患者的流行病学、通气管理和结局的信息仍然很少。本研究旨在检验术后通气是否与手术室中的通气不同。
这是一项全球性观察性 LAS VEGAS 研究的子研究，纳入了接受非胸部手术的患者。在参与 LAS VEGAS 研究的 146 个研究点中，有 117 个（80%）报告了术后 ICU 病程，包括通气和并发症。主要结局是通气管理的两个关键要素，即潮气量（V）和呼气末正压（PEEP）。次要结局包括接受低 V 通气（LTVV，定义为通气时中位 V<8.0ml/kg 预测体重（PBW））的患者比例，以及发生术后肺部并发症（PPC）的患者比例，包括 ARDS、气胸、肺炎和需要升级通气支持、ICU 和住院时间、以及 28 天时的死亡率。
在术后入住 ICU 的 653 名患者中，有 274 名（42%）患者接受了术后有创通气。术后中位 V 为 8.4[7.3-9.8]ml/kg PBW，PEEP 为 5[5-5]cm HO，与术中 V（8.1[7.3-8.9]ml/kg PBW；P<0.001）和 PEEP（4[2-5]cm HO；P<0.001）相比，虽有统计学差异但无临床意义。术后接受 LTVV 的患者比例为 41%。PPC 发生率为 10%。ICU 和住院时间与 PPC 的发生无关，但发生 PPC 的患者住院死亡率更高（24%比 4%；P<0.001）。
在这项接受非胸部手术患者的观察性研究中，术后通气与手术室中的通气无明显差异。与手术室中一样，LTVV 的使用仍有改进空间。PPC 的发生与死亡率相关。
