Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, University of Seoul National College of Medicine, Seoul, South Korea.
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Anesthesiology. 2024 May 1;140(5):920-934. doi: 10.1097/ALN.0000000000004879.
Mechanical power (MP), the rate of mechanical energy (ME) delivery, is a recently introduced unifying ventilator parameter consisting of tidal volume, airway pressures, and respiratory rates, which predicts pulmonary complications in several clinical contexts. However, ME has not been previously studied in the perioperative context, and neither parameter has been studied in the context of thoracic surgery utilizing one-lung ventilation.
The relationships between ME variables and postoperative pulmonary complications were evaluated in this post hoc analysis of data from a multicenter randomized clinical trial of lung resection surgery conducted between 2020 and 2021 (n = 1,170). Time-weighted average MP and ME (the area under the MP time curve) were obtained for individual patients. The primary analysis was the association of time-weighted average MP and ME with pulmonary complications within 7 postoperative days. Multivariable logistic regression was performed to examine the relationships between energy variables and the primary outcome.
In 1,055 patients analyzed, pulmonary complications occurred in 41% (431 of 1,055). The median (interquartile ranges) ME and time-weighted average MP in patients who developed postoperative pulmonary complications versus those who did not were 1,146 (811 to 1,530) J versus 924 (730 to 1,240) J (P < 0.001), and 6.9 (5.5 to 8.7) J/min versus 6.7 (5.2 to 8.5) J/min (P = 0.091), respectively. ME was independently associated with postoperative pulmonary complications (ORadjusted, 1.44 [95% CI, 1.16 to 1.80]; P = 0.001). However, the association between time-weighted average MP and postoperative pulmonary complications was time-dependent, and time-weighted average MP was significantly associated with postoperative pulmonary complications in cases utilizing longer periods of mechanical ventilation (210 min or greater; ORadjusted, 1.46 [95% CI, 1.11 to 1.93]; P = 0.007). Normalization of ME and time-weighted average MP either to predicted body weight or to respiratory system compliance did not alter these associations.
ME and, in cases requiring longer periods of mechanical ventilation, MP were independently associated with postoperative pulmonary complications in thoracic surgery.
机械功率（MP）是机械能量（ME）传递率，是一种最近引入的统一呼吸机参数，由潮气量、气道压力和呼吸频率组成，可预测几种临床情况下的肺部并发症。然而，ME 尚未在围手术期进行研究，也没有参数在利用单肺通气的胸科手术情况下进行研究。
本研究对 2020 年至 2021 年间进行的肺切除术多中心随机临床试验（n=1170）的数据进行了事后分析，评估了 ME 变量与术后肺部并发症之间的关系。为每位患者获得时间加权平均 MP 和 ME（MP 时间曲线下的面积）。主要分析是时间加权平均 MP 和 ME 与术后 7 天内肺部并发症的关系。进行多变量逻辑回归分析以检查能量变量与主要结局之间的关系。
在 1055 例分析患者中，41%（431/1055）发生肺部并发症。发生术后肺部并发症的患者与未发生肺部并发症的患者的 ME 和时间加权平均 MP 中位数（四分位数间距）分别为 1146（811 至 1530）J 与 924（730 至 1240）J（P<0.001），6.9（5.5 至 8.7）J/min 与 6.7（5.2 至 8.5）J/min（P=0.091）。ME 与术后肺部并发症独立相关（调整后的 OR，1.44[95%CI，1.16 至 1.80]；P=0.001）。然而，时间加权平均 MP 与术后肺部并发症之间的关系是时间依赖性的，在使用机械通气时间较长（210 分钟或更长时间）的情况下，时间加权平均 MP 与术后肺部并发症显著相关（调整后的 OR，1.46[95%CI，1.11 至 1.93]；P=0.007）。将 ME 和时间加权平均 MP 分别归一化为预测体重或呼吸系统顺应性，并没有改变这些关联。
ME 以及在需要较长机械通气时间的情况下，MP 与胸科手术后肺部并发症独立相关。
