Intraoperative ventilator settings and their association with postoperative pulmonary complications in neurosurgical patients: Post-hoc analysis of LAS VEGAS study

Chiara Robba, Sabrine N.T. Hemmes, Ary Serpa Neto, Thomas Bluth, Jaume Canet, Michael Hiesmayr, M. Wiersma Hollmann, Gary H. Mills, Marcos F. Vidal Melo, Christian Putensen, Samir Jaber, Werner Schmid, Paolo Severgnini, Hermann Wrigge, Denise Battaglini, Lorenzo Ball, Marcelo Gama De Abreu, Marcus J. Schultz, Paolo Pelosi, for the LAS VEGAS investigators and the PROtective VEntilation Network and the Clinical Trial Network of the European Society of Anaesthesiology

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Abstract

Background: Limited information is available regarding intraoperative ventilator settings and the incidence of postoperative pulmonary complications (PPCs) in patients undergoing neurosurgical procedures. The aim of this post-hoc analysis of the 'Multicentre Local ASsessment of VEntilatory management during General Anaesthesia for Surgery' (LAS VEGAS) study was to examine the ventilator settings of patients undergoing neurosurgical procedures, and to explore the association between perioperative variables and the development of PPCs in neurosurgical patients. Methods: Post-hoc analysis of LAS VEGAS study, restricted to patients undergoing neurosurgery. Patients were stratified into groups based on the type of surgery (brain and spine), the occurrence of PPCs and the assess respiratory risk in surgical patients in Catalonia (ARISCAT) score risk for PPCs. Results: Seven hundred eighty-four patients were included in the analysis; 408 patients (52%) underwent spine surgery and 376 patients (48%) brain surgery. Median tidal volume (VT) was 8 ml [Interquartile Range, IQR = 7.3-9] per predicted body weight; median positive end-expiratory pressure (PEEP) was 5 [3 to 5] cmH20. Planned recruitment manoeuvres were used in the 6.9% of patients. No differences in ventilator settings were found among the sub-groups. PPCs occurred in 81 patients (10.3%). Duration of anaesthesia (odds ratio, 1.295 [95% confidence interval 1.067 to 1.572]; p = 0.009) and higher age for the brain group (odds ratio, 0.000 [0.000 to 0.189]; p = 0.031), but not intraoperative ventilator settings were independently associated with development of PPCs. Conclusions: Neurosurgical patients are ventilated with low VT and low PEEP, while recruitment manoeuvres are seldom applied. Intraoperative ventilator settings are not associated with PPCs.

Original languageEnglish
Article number73
Number of pages14
JournalBMC Anesthesiology
Volume20
Issue number1
DOIs
Publication statusPublished - 2 Apr 2020
Externally publishedYes

Keywords

  • LAS VEGAS
  • Mechanical ventilation
  • Neurosurgery
  • Postoperative pulmonary complications

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