Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia

A meta-analysis of individual patient data

Ary Serpa Neto, Sabrine N T Hemmes, Carmen S V Barbas, Martin Beiderlinden, Ana Fernandez-Bustamante, Emmanuel Futier, Ognjen Gajic, Mohamed R. El-Tahan, Abdulmohsin A Al Ghamdi, Ersin Günay, Samir Jaber, Serdar Kokulu, Alf Kozian, Marc Licker, Wen Qian Lin, Andrew D. Maslow, Stavros G. Memtsoudis, Dinis Reis Miranda, Pierre Moine, Thomas Ng & 19 others Domenico Paparella, V. Marco Ranieri, Federica Scavonetto, Thomas Schilling, Gabriele Selmo, Paolo Severgnini, Juraj Sprung, Sugantha Sundar, Daniel Talmor, Tanja Treschan, Carmen Unzueta, Toby N. Weingarten, Esther K. Wolthuis, Hermann Wrigge, Marcelo B P Amato, Eduardo L V Costa, Marcelo Gama de Abreu, Paolo Pelosi, Marcus J. Schultz

Research output: Contribution to journalArticle

138 Citations (Scopus)

Abstract

Background: Protective mechanical ventilation strategies using low tidal volume or high levels of positive end-expiratory pressure (PEEP) improve outcomes for patients who have had surgery. The role of the driving pressure, which is the difference between the plateau pressure and the level of positive end-expiratory pressure is not known. We investigated the association of tidal volume, the level of PEEP, and driving pressure during intraoperative ventilation with the development of postoperative pulmonary complications. Methods: We did a meta-analysis of individual patient data from randomised controlled trials of protective ventilation during general anesthaesia for surgery published up to July 30, 2015. The main outcome was development of postoperative pulmonary complications (postoperative lung injury, pulmonary infection, or barotrauma). Findings: We included data from 17 randomised controlled trials, including 2250 patients. Multivariate analysis suggested that driving pressure was associated with the development of postoperative pulmonary complications (odds ratio [OR] for one unit increase of driving pressure 1·16, 95% CI 1·13-1·19; p

Original languageEnglish (US)
JournalThe Lancet Respiratory Medicine
DOIs
StateAccepted/In press - 2016

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Artificial Respiration
General Anesthesia
Meta-Analysis
Positive-Pressure Respiration
Pressure
Lung
Tidal Volume
Ventilation
Randomized Controlled Trials
Barotrauma
Lung Injury
Multivariate Analysis
Odds Ratio
Infection

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia : A meta-analysis of individual patient data. / Neto, Ary Serpa; Hemmes, Sabrine N T; Barbas, Carmen S V; Beiderlinden, Martin; Fernandez-Bustamante, Ana; Futier, Emmanuel; Gajic, Ognjen; El-Tahan, Mohamed R.; Ghamdi, Abdulmohsin A Al; Günay, Ersin; Jaber, Samir; Kokulu, Serdar; Kozian, Alf; Licker, Marc; Lin, Wen Qian; Maslow, Andrew D.; Memtsoudis, Stavros G.; Miranda, Dinis Reis; Moine, Pierre; Ng, Thomas; Paparella, Domenico; Ranieri, V. Marco; Scavonetto, Federica; Schilling, Thomas; Selmo, Gabriele; Severgnini, Paolo; Sprung, Juraj; Sundar, Sugantha; Talmor, Daniel; Treschan, Tanja; Unzueta, Carmen; Weingarten, Toby N.; Wolthuis, Esther K.; Wrigge, Hermann; Amato, Marcelo B P; Costa, Eduardo L V; de Abreu, Marcelo Gama; Pelosi, Paolo; Schultz, Marcus J.

In: The Lancet Respiratory Medicine, 2016.

Research output: Contribution to journalArticle

Neto, AS, Hemmes, SNT, Barbas, CSV, Beiderlinden, M, Fernandez-Bustamante, A, Futier, E, Gajic, O, El-Tahan, MR, Ghamdi, AAA, Günay, E, Jaber, S, Kokulu, S, Kozian, A, Licker, M, Lin, WQ, Maslow, AD, Memtsoudis, SG, Miranda, DR, Moine, P, Ng, T, Paparella, D, Ranieri, VM, Scavonetto, F, Schilling, T, Selmo, G, Severgnini, P, Sprung, J, Sundar, S, Talmor, D, Treschan, T, Unzueta, C, Weingarten, TN, Wolthuis, EK, Wrigge, H, Amato, MBP, Costa, ELV, de Abreu, MG, Pelosi, P & Schultz, MJ 2016, 'Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: A meta-analysis of individual patient data', The Lancet Respiratory Medicine. https://doi.org/10.1016/S2213-2600(16)00057-6
Neto, Ary Serpa ; Hemmes, Sabrine N T ; Barbas, Carmen S V ; Beiderlinden, Martin ; Fernandez-Bustamante, Ana ; Futier, Emmanuel ; Gajic, Ognjen ; El-Tahan, Mohamed R. ; Ghamdi, Abdulmohsin A Al ; Günay, Ersin ; Jaber, Samir ; Kokulu, Serdar ; Kozian, Alf ; Licker, Marc ; Lin, Wen Qian ; Maslow, Andrew D. ; Memtsoudis, Stavros G. ; Miranda, Dinis Reis ; Moine, Pierre ; Ng, Thomas ; Paparella, Domenico ; Ranieri, V. Marco ; Scavonetto, Federica ; Schilling, Thomas ; Selmo, Gabriele ; Severgnini, Paolo ; Sprung, Juraj ; Sundar, Sugantha ; Talmor, Daniel ; Treschan, Tanja ; Unzueta, Carmen ; Weingarten, Toby N. ; Wolthuis, Esther K. ; Wrigge, Hermann ; Amato, Marcelo B P ; Costa, Eduardo L V ; de Abreu, Marcelo Gama ; Pelosi, Paolo ; Schultz, Marcus J. / Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia : A meta-analysis of individual patient data. In: The Lancet Respiratory Medicine. 2016.
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abstract = "Background: Protective mechanical ventilation strategies using low tidal volume or high levels of positive end-expiratory pressure (PEEP) improve outcomes for patients who have had surgery. The role of the driving pressure, which is the difference between the plateau pressure and the level of positive end-expiratory pressure is not known. We investigated the association of tidal volume, the level of PEEP, and driving pressure during intraoperative ventilation with the development of postoperative pulmonary complications. Methods: We did a meta-analysis of individual patient data from randomised controlled trials of protective ventilation during general anesthaesia for surgery published up to July 30, 2015. The main outcome was development of postoperative pulmonary complications (postoperative lung injury, pulmonary infection, or barotrauma). Findings: We included data from 17 randomised controlled trials, including 2250 patients. Multivariate analysis suggested that driving pressure was associated with the development of postoperative pulmonary complications (odds ratio [OR] for one unit increase of driving pressure 1·16, 95{\%} CI 1·13-1·19; p",
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T1 - Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia

T2 - A meta-analysis of individual patient data

AU - Neto, Ary Serpa

AU - Hemmes, Sabrine N T

AU - Barbas, Carmen S V

AU - Beiderlinden, Martin

AU - Fernandez-Bustamante, Ana

AU - Futier, Emmanuel

AU - Gajic, Ognjen

AU - El-Tahan, Mohamed R.

AU - Ghamdi, Abdulmohsin A Al

AU - Günay, Ersin

AU - Jaber, Samir

AU - Kokulu, Serdar

AU - Kozian, Alf

AU - Licker, Marc

AU - Lin, Wen Qian

AU - Maslow, Andrew D.

AU - Memtsoudis, Stavros G.

AU - Miranda, Dinis Reis

AU - Moine, Pierre

AU - Ng, Thomas

AU - Paparella, Domenico

AU - Ranieri, V. Marco

AU - Scavonetto, Federica

AU - Schilling, Thomas

AU - Selmo, Gabriele

AU - Severgnini, Paolo

AU - Sprung, Juraj

AU - Sundar, Sugantha

AU - Talmor, Daniel

AU - Treschan, Tanja

AU - Unzueta, Carmen

AU - Weingarten, Toby N.

AU - Wolthuis, Esther K.

AU - Wrigge, Hermann

AU - Amato, Marcelo B P

AU - Costa, Eduardo L V

AU - de Abreu, Marcelo Gama

AU - Pelosi, Paolo

AU - Schultz, Marcus J.

PY - 2016

Y1 - 2016

N2 - Background: Protective mechanical ventilation strategies using low tidal volume or high levels of positive end-expiratory pressure (PEEP) improve outcomes for patients who have had surgery. The role of the driving pressure, which is the difference between the plateau pressure and the level of positive end-expiratory pressure is not known. We investigated the association of tidal volume, the level of PEEP, and driving pressure during intraoperative ventilation with the development of postoperative pulmonary complications. Methods: We did a meta-analysis of individual patient data from randomised controlled trials of protective ventilation during general anesthaesia for surgery published up to July 30, 2015. The main outcome was development of postoperative pulmonary complications (postoperative lung injury, pulmonary infection, or barotrauma). Findings: We included data from 17 randomised controlled trials, including 2250 patients. Multivariate analysis suggested that driving pressure was associated with the development of postoperative pulmonary complications (odds ratio [OR] for one unit increase of driving pressure 1·16, 95% CI 1·13-1·19; p

AB - Background: Protective mechanical ventilation strategies using low tidal volume or high levels of positive end-expiratory pressure (PEEP) improve outcomes for patients who have had surgery. The role of the driving pressure, which is the difference between the plateau pressure and the level of positive end-expiratory pressure is not known. We investigated the association of tidal volume, the level of PEEP, and driving pressure during intraoperative ventilation with the development of postoperative pulmonary complications. Methods: We did a meta-analysis of individual patient data from randomised controlled trials of protective ventilation during general anesthaesia for surgery published up to July 30, 2015. The main outcome was development of postoperative pulmonary complications (postoperative lung injury, pulmonary infection, or barotrauma). Findings: We included data from 17 randomised controlled trials, including 2250 patients. Multivariate analysis suggested that driving pressure was associated with the development of postoperative pulmonary complications (odds ratio [OR] for one unit increase of driving pressure 1·16, 95% CI 1·13-1·19; p

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U2 - 10.1016/S2213-2600(16)00057-6

DO - 10.1016/S2213-2600(16)00057-6

M3 - Article

JO - The Lancet Respiratory Medicine

JF - The Lancet Respiratory Medicine

SN - 2213-2600

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