TY - JOUR
T1 - Intraoperative ventilation settings and their associations with postoperative pulmonary complications in obese patients
AU - Ball, L.
AU - Hemmes, S. N.T.
AU - Serpa Neto, A.
AU - Bluth, T.
AU - Canet, J.
AU - Hiesmayr, M.
AU - Hollmann, M. W.
AU - Mills, G. H.
AU - Vidal Melo, M. F.
AU - Putensen, C.
AU - Schmid, W.
AU - Severgnini, P.
AU - Wrigge, H.
AU - Gama de Abreu, M.
AU - Schultz, M. J.
AU - Pelosi, P.
AU - for the LAS VEGAS investigators, the PROVE Network, the Clinical Trial Network of the European Society of Anaesthesiology
PY - 2018/10
Y1 - 2018/10
N2 - Background: There is limited information concerning the current practice of intraoperative mechanical ventilation in obese patients, and the optimal ventilator settings for these patients are debated. We investigated intraoperative ventilation parameters and their associations with the development of postoperative pulmonary complications (PPCs) in obese patients. Methods: We performed a secondary analysis of the international multicentre Local ASsessment of VEntilatory management during General Anesthesia for Surgery’ (LAS VEGAS) study, restricted to obese patients, with a predefined composite outcome of PPCs as primary end-point. Results: We analysed 2012 obese patients from 135 hospitals across 29 countries in Europe, North America, North Africa, and the Middle East. Tidal volume was 8.8 [25th–75th percentiles: 7.8–9.9] ml kg−1 predicted body weight, PEEP was 4 [1–5] cm H2O, and recruitment manoeuvres were performed in 7.7% of patients. PPCs occurred in 11.7% of patients and were independently associated with age (P<0.001), body mass index ≥40 kg m−2 (P=0.033), obstructive sleep apnoea (P=0.002), duration of anaesthesia (P<0.001), peak airway pressure (P<0.001), use of rescue recruitment manoeuvres (P<0.05) and routine recruitment manoeuvres performed by bag squeezing (P=0.021). PPCs were associated with an increased length of hospital stay (P<0.001). Conclusions: Obese patients are frequently ventilated with high tidal volume and low PEEP, and seldom receive recruitment manoeuvres. PPCs increase hospital stay, and are associated with preoperative conditions, duration of anaesthesia and intraoperative ventilation settings. Randomised trials are warranted to clarify the role of different ventilatory parameters in obese patients. Clinical trial registration: NCT01601223.
AB - Background: There is limited information concerning the current practice of intraoperative mechanical ventilation in obese patients, and the optimal ventilator settings for these patients are debated. We investigated intraoperative ventilation parameters and their associations with the development of postoperative pulmonary complications (PPCs) in obese patients. Methods: We performed a secondary analysis of the international multicentre Local ASsessment of VEntilatory management during General Anesthesia for Surgery’ (LAS VEGAS) study, restricted to obese patients, with a predefined composite outcome of PPCs as primary end-point. Results: We analysed 2012 obese patients from 135 hospitals across 29 countries in Europe, North America, North Africa, and the Middle East. Tidal volume was 8.8 [25th–75th percentiles: 7.8–9.9] ml kg−1 predicted body weight, PEEP was 4 [1–5] cm H2O, and recruitment manoeuvres were performed in 7.7% of patients. PPCs occurred in 11.7% of patients and were independently associated with age (P<0.001), body mass index ≥40 kg m−2 (P=0.033), obstructive sleep apnoea (P=0.002), duration of anaesthesia (P<0.001), peak airway pressure (P<0.001), use of rescue recruitment manoeuvres (P<0.05) and routine recruitment manoeuvres performed by bag squeezing (P=0.021). PPCs were associated with an increased length of hospital stay (P<0.001). Conclusions: Obese patients are frequently ventilated with high tidal volume and low PEEP, and seldom receive recruitment manoeuvres. PPCs increase hospital stay, and are associated with preoperative conditions, duration of anaesthesia and intraoperative ventilation settings. Randomised trials are warranted to clarify the role of different ventilatory parameters in obese patients. Clinical trial registration: NCT01601223.
KW - anaesthesia
KW - general
KW - obesity
KW - perioperative care
KW - postoperative complications
UR - http://www.scopus.com/inward/record.url?scp=85047804388&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2018.04.021
DO - 10.1016/j.bja.2018.04.021
M3 - Article
C2 - 30236252
AN - SCOPUS:85047804388
SN - 0007-0912
VL - 121
SP - 899
EP - 908
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 4
ER -