TY - JOUR
T1 - Associations Between Expiratory Flow Limitation and Postoperative Pulmonary Complications in Patients Undergoing Cardiac Surgery
AU - Ball, Lorenzo
AU - Volta, Carlo Alberto
AU - Saglietti, Francesco
AU - Spadaro, Savino
AU - Di Lullo, Antonio
AU - De Simone, Giulio
AU - Guarnieri, Marcello
AU - Della Corte, Francesca
AU - Serpa Neto, Ary
AU - Gama de Abreu, Marcelo
AU - Schultz, Marcus J.
AU - Zangrillo, Alberto
AU - Pelosi, Paolo
AU - Bignami, Elena
N1 - Funding Information:
Prof. M. Gama de Abreu disclosed financial relationships with Dr?ger Medical, GE Healthcare, Ambu. All other authors have no conflict of interest to disclose.
Publisher Copyright:
© 2021 Elsevier Inc.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - Objectives: To determine whether driving pressure and expiratory flow limitation are associated with the development of postoperative pulmonary complications (PPCs) in cardiac surgery patients. Design: Prospective cohort study. Setting: University Hospital San Raffaele, Milan, Italy. Participants: Patients undergoing elective cardiac surgery. Measurements and Main Results: The primary endpoint was the occurrence of a predefined composite of PPCs. The authors determined the association among PPCs and intraoperative ventilation parameters, mechanical power and energy load, and occurrence of expiratory flow limitation (EFL) assessed with the positive end-expiratory pressure test. Two hundred patients were enrolled, of whom 78 (39%) developed one or more PPCs. Patients with PPCs, compared with those without PPCs, had similar driving pressure (mean difference [MD] –0.1 [95% confidence interval (CI), –1.0 to 0.7] cmH2O, p = 0.561), mechanical power (MD 0.5 [95% CI, –0.3 to 1.1] J/m, p = 0.364), and total energy load (MD 95 [95% CI, –78 to 263] J, p = 0.293), but they had a higher incidence of EFL (51% v 38%, p = 0.005). Only EFL was associated independently with the development of PPCs (odds ratio 2.46 [95% CI, 1.28-4.80], p = 0.007). Conclusions: PPCs occurred frequently in this patient population undergoing cardiac surgery. PPCs were associated independently with the presence of EFL but not with driving pressure, total energy load, or mechanical power.
AB - Objectives: To determine whether driving pressure and expiratory flow limitation are associated with the development of postoperative pulmonary complications (PPCs) in cardiac surgery patients. Design: Prospective cohort study. Setting: University Hospital San Raffaele, Milan, Italy. Participants: Patients undergoing elective cardiac surgery. Measurements and Main Results: The primary endpoint was the occurrence of a predefined composite of PPCs. The authors determined the association among PPCs and intraoperative ventilation parameters, mechanical power and energy load, and occurrence of expiratory flow limitation (EFL) assessed with the positive end-expiratory pressure test. Two hundred patients were enrolled, of whom 78 (39%) developed one or more PPCs. Patients with PPCs, compared with those without PPCs, had similar driving pressure (mean difference [MD] –0.1 [95% confidence interval (CI), –1.0 to 0.7] cmH2O, p = 0.561), mechanical power (MD 0.5 [95% CI, –0.3 to 1.1] J/m, p = 0.364), and total energy load (MD 95 [95% CI, –78 to 263] J, p = 0.293), but they had a higher incidence of EFL (51% v 38%, p = 0.005). Only EFL was associated independently with the development of PPCs (odds ratio 2.46 [95% CI, 1.28-4.80], p = 0.007). Conclusions: PPCs occurred frequently in this patient population undergoing cardiac surgery. PPCs were associated independently with the presence of EFL but not with driving pressure, total energy load, or mechanical power.
KW - cardiac surgery
KW - driving pressure
KW - expiratory flow limitation
KW - mechanical power
KW - postoperative pulmonary complications
UR - http://www.scopus.com/inward/record.url?scp=85112556796&partnerID=8YFLogxK
U2 - 10.1053/j.jvca.2021.07.035
DO - 10.1053/j.jvca.2021.07.035
M3 - Article
C2 - 34404594
AN - SCOPUS:85112556796
SN - 1053-0770
VL - 36
SP - 815
EP - 824
JO - Journal of Cardiothoracic and Vascular Anesthesia
JF - Journal of Cardiothoracic and Vascular Anesthesia
IS - 3
ER -