Chen Mei-Fang, Xie Lin-Feng, Lin Xin-Fan, Wu Ping-Ping, Zhang Jia-Xin, Lin Yong
Department of Cardiovascular Surgery , Fujian Medical University Union Hospital , No. 29 Xinquan Road, Fujian, 350001, Fuzhou, China.
Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, China.
Sci Rep. 2025 Jan 5;15(1):856. doi: 10.1038/s41598-025-85283-w.
This study aimed to investigate whether driving pressure-guided ventilation can reduce postoperative pulmonary complications in patients who have undergone heart transplantation. Patients who underwent orthotopic heart transplantation were divided into two groups according to the perioperative ventilation strategy: (1) conventional lung-protective ventilation (group C) and (2) driving pressure-guided ventilation (group D). The primary outcome was the occurrence of postoperative pulmonary complications within 30 days of surgery. Univariate and multivariate logistic regression analyses were performed to evaluate the independent risk factors associated with postoperative pulmonary complications (PPCs). Compared with group C, patients in group D exhibited lower driving pressure. Oxygenation improved significantly in the early period after surgery in patients in group D. Group C exhibited a higher number of patients with postoperative pulmonary complications, especially respiratory infections and atelectasis. Patients in group D experienced a shorter duration of postoperative mechanical ventilation and a shorter stay in the intensive care unit. The conventional ventilation strategy, the high driving pressure level and the low PaO2 value at the end of the surgery were the independent risk factors for PPCs in heart transplantation. Compared with conventional lung-protective ventilation, driving pressure-guided ventilation was associated with improved pulmonary oxygenation and lower incidences of pulmonary complications among patients after heart transplantation.
本研究旨在调查驱动压力引导通气是否能降低心脏移植术后患者的肺部并发症。接受原位心脏移植的患者根据围手术期通气策略分为两组：（1）传统肺保护性通气组（C组）和（2）驱动压力引导通气组（D组）。主要结局是术后30天内肺部并发症的发生情况。进行单因素和多因素逻辑回归分析以评估与术后肺部并发症（PPCs）相关的独立危险因素。与C组相比，D组患者的驱动压力较低。D组患者术后早期氧合显著改善。C组术后肺部并发症患者数量较多，尤其是呼吸道感染和肺不张。D组患者术后机械通气时间较短，在重症监护病房的住院时间较短。传统通气策略、手术结束时较高的驱动压力水平和较低的PaO2值是心脏移植患者发生PPCs的独立危险因素。与传统肺保护性通气相比，驱动压力引导通气与心脏移植术后患者肺部氧合改善和肺部并发症发生率降低相关。
