非心胸外科择期手术患者的术中机械功率与术后肺部并发症：一项10年回顾性队列研究

Intraoperative Mechanical Power and Postoperative Pulmonary Complications in Noncardiothoracic Elective Surgery Patients: A 10-Year Retrospective Cohort Study.

作者信息

Elefterion Bertrand, Cirenei Cedric, Kipnis Eric, Cailliau Emeline, Bruandet Amélie, Tavernier Benoit, Lamer Antoine, Lebuffe Gilles

机构信息

Lille University Hospital, Surgical Critical Care, Department of Anesthesiology and Critical Care, Lille, France.

Lille University Hospital, Biostatistics Department, Lille, France.

出版信息

Anesthesiology. 2024 Mar 1;140(3):399-408. doi: 10.1097/ALN.0000000000004848.

DOI:10.1097/ALN.0000000000004848

PMID:38011027

Abstract

BACKGROUND

Postoperative pulmonary complications is a major issue that affects outcomes of surgical patients. The hypothesis was that the intraoperative ventilation parameters are associated with occurrence of postoperative pulmonary complications.

METHODS

A single-center retrospective cohort study was conducted at the Lille University Hospital, France. The study included 33,701 adults undergoing noncardiac, nonthoracic elective surgery requiring general anesthesia with tracheal intubation between January 2010 and December 2019. Intraoperative ventilation parameters were compared between patients with and without one or more postoperative pulmonary complications (respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, bronchospasm, and aspiration pneumonitis) within 7 days of surgery.

RESULTS

Among 33,701 patients, 2,033 (6.0%) had one or more postoperative pulmonary complications. The lower tidal volume to predicted body weight ratio (odds ratio per -1 ml·kgPBW-1, 1.08; 95% CI, 1.02 to 1.14; P < 0.001), higher mechanical power (odds ratio per 4 J·min-1, 1.37; 95% CI, 1.26 to 1.49; P < 0.001), dynamic respiratory system compliance less than 30 ml·cm H2O (1.30; 95% CI, 1.15 to 1.46; P < 0.001), oxygen saturation measured by pulse oximetry less than 96% (odds ratio, 2.42; 95% CI, 1.97 to 2.96; P < 0.001), and lower end-tidal carbon dioxide (odds ratio per -3 mmHg, 1.06; 95% CI, 1.00 to 1.13; P = 0.023) were independently associated with postoperative pulmonary complications. Patients with postoperative pulmonary complications were more likely to be admitted to the intensive care unit (odds ratio, 12.5; 95% CI, 6.6 to 10.1; P < 0.001), had longer hospital length of stay (subhazard ratio, 0.43; 95% CI, 0.40 to 0.45), and higher in-hospital (subhazard ratio, 6.0; 95% CI, 4.1 to 9.0; P < 0.001) and 1-yr mortality (subhazard ratio, 2.65; 95% CI, 2.33 to 3.02; P < 0.001).

CONCLUSIONS

In the study's population, decreased rather than increased tidal volume, decreased compliance, increased mechanical power, and decreased end-tidal carbon dioxide were independently associated with postoperative pulmonary complications.

摘要

背景

术后肺部并发症是影响手术患者预后的一个主要问题。研究假设是术中通气参数与术后肺部并发症的发生有关。

方法

在法国里尔大学医院进行了一项单中心回顾性队列研究。该研究纳入了2010年1月至2019年12月期间33701例接受非心脏、非胸部择期手术且需要气管插管全身麻醉的成年人。比较了手术7天内发生或未发生一种或多种术后肺部并发症（呼吸道感染、呼吸衰竭、胸腔积液、肺不张、气胸、支气管痉挛和吸入性肺炎）的患者的术中通气参数。

结果

在33701例患者中，2033例（6.0%）发生了一种或多种术后肺部并发症。较低的潮气量与预测体重比（每降低-1 ml·kgPBW-1的比值比为1.08；95%可信区间为1.02至1.14；P<0.001）、较高的机械功率（每增加4 J·min-1的比值比为1.37；95%可信区间为1.26至1.49；P<0.001）、动态呼吸系统顺应性小于30 ml·cm H2O（1.30；95%可信区间为1.15至1.46；P<0.001）、经脉搏血氧饱和度测定的氧饱和度低于96%（比值比为2.42；95%可信区间为1.97至2.96；P<0.001）以及较低的呼气末二氧化碳（每降低-3 mmHg的比值比为1.06；95%可信区间为1.00至1.13；P=0.023）与术后肺部并发症独立相关。发生术后肺部并发症的患者更有可能入住重症监护病房（比值比为12.5；95%可信区间为6.6至10.1；P<0.001），住院时间更长（风险比为0.43；95%可信区间为0.40至0.45），院内死亡率更高（风险比为6.0；95%可信区间为4.1至9.0；P<0.001）以及1年死亡率更高（风险比为2.65；95%可信区间为2.33至3.02；P<0.001）。结论：在该研究人群中，潮气量降低而非增加、顺应性降低、机械功率增加以及呼气末二氧化碳降低与术后肺部并发症独立相关。