医学
置信区间
机械通风
高原压力
平均气道压
麻醉
通风(建筑)
持续气道正压
肺顺应性
随机对照试验
四分位数
外科
肺
内科学
急性呼吸窘迫综合征
机械工程
阻塞性睡眠呼吸暂停
工程类
作者
MiHye Park,Susie Yoon,Jae‐Sik Nam,Hyun Joo Ahn,Heezoo Kim,Hye Jin Kim,Hoon Choi,Hong Kwan Kim,Randal S. Blank,Sung‐Cheol Yun,Dong Kyu Lee,Mikyung Yang,Jie Ae Kim,In‐Sun Song,Bo Rim Kim,Jang J. Bahk,Juyoun Kim,S. Lee,In‐Cheol Choi,Young Jun Oh,Wonjung Hwang,Byung Gun Lim,Burn Young Heo
标识
DOI:10.1016/j.bja.2022.06.037
摘要
Airway driving pressure, easily measured as plateau pressure minus PEEP, is a surrogate for alveolar stress and strain. However, the effect of its targeted reduction remains unclear.In this multicentre trial, patients undergoing lung resection surgery were randomised to either a driving pressure group (n=650) receiving an alveolar recruitment/individualised PEEP to deliver the lowest driving pressure or to a conventional protective ventilation group (n=650) with fixed PEEP of 5 cm H2O. The primary outcome was a composite of pulmonary complications within 7 days postoperatively.The modified intention-to-treat analysis included 1170 patients (mean [standard deviation, sd]; age, 63 [10] yr; 47% female). The mean driving pressure was 7.1 cm H2O in the driving pressure group vs 9.2 cm H2O in the protective ventilation group (mean difference [95% confidence interval, CI]; -2.1 [-2.4 to -1.9] cm H2O; P<0.001). The incidence of pulmonary complications was not different between the two groups: driving pressure group (233/576, 40.5%) vs protective ventilation group (254/594, 42.8%) (risk difference -2.3%; 95% CI, -8.0% to 3.3%; P=0.42). Intraoperatively, lung compliance (mean [sd], 42.7 [12.4] vs 33.5 [11.1] ml cm H2O-1; P<0.001) and Pao2 (median [inter-quartile range], 21.5 [14.5 to 30.4] vs 19.5 [13.5 to 29.1] kPa; P=0.03) were higher and the need for rescue ventilation was less frequent (6.8% vs 10.8%; P=0.02) in the driving pressure group.In lung resection surgery, a driving pressure-guided ventilation improved pulmonary mechanics intraoperatively, but did not reduce the incidence of postoperative pulmonary complications compared with a conventional protective ventilation.NCT04260451.
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