Intraoperative ventilator settings and acute lung injury after elective surgery: A nested case control study

E. R. Fernández-Pérez, J. Sprung, B. Afessa, David Oman Warner, Celine M Vachon, D. R. Schroeder, D. R. Brown, R. D. Hubmayr, Ognjen Gajic

Research output: Contribution to journalArticle

107 Citations (Scopus)

Abstract

Background: While acute lung injury (ALI) is among the most serious postoperative pulmonary complications, its incidence, risk factors and outcome have not been prospectively studied. Objective: To determine the incidence and survival of ALI associated postoperative respiratory failure and its association with intraoperative ventilator settings, specifically tidal volume. Design: Prospective, nested, case control study. Setting: Single tertiary referral centre. Patients: 4420 consecutive patients without ALI undergoing high risk elective surgeries for postoperative pulmonary complications. Measurements: Incidence of ALI, survival and 2:1 matched case control comparison of intraoperative exposures. Results: 238 (5.4%) patients developed postoperative respiratory failure. Causes included ALI in 83 (35%), hydrostatic pulmonary oedema in 74 (31%), shock in 27 (11.3%), pneumonia in nine (4%), carbon dioxide retention in eight (3.4%) and miscellaneous in 37 (15%). Compared with match controls (n = 166), ALI cases had lower 60 day and 1 year survival (99% vs 73% and 92% vs 56%; p<0.001). Cases were more likely to have a history of smoking, chronic obstructive pulmonary disease and diabetes, and to be exposed to longer duration of surgery, intraoperative hypotension and larger amount of fluid and transfusions. After adjustment for non-ventilator parameters, mean first hour peak airway pressure (OR 1.07; 95% CI 1.02 to 1.15 cm H 2O) but not tidal volume (OR 1.03; 95% CI 0.84 to 1.26 ml/kg), positive end expiratory pressure (OR 0.89; 95% CI 0.77 to 1.04 cm H 2O) or fraction of inspired oxygen (OR 1.0; 95% CI 0.98 to 1.03) were associated with ALI. Conclusion: ALI is the most common cause of postoperative respiratory failure and is associated with markedly lower postoperative survival. Intraoperative tidal volume was not associated with an increased risk for early postoperative ALI.

Original languageEnglish (US)
Pages (from-to)121-127
Number of pages7
JournalThorax
Volume64
Issue number2
DOIs
StatePublished - Feb 2009

Fingerprint

Acute Lung Injury
Mechanical Ventilators
Case-Control Studies
Tidal Volume
Respiratory Insufficiency
Survival
Incidence
Lung
Positive-Pressure Respiration
Pulmonary Edema
Tertiary Care Centers
Carbon Dioxide
Hypotension
Chronic Obstructive Pulmonary Disease
Shock
Pneumonia
Smoking
Oxygen
Pressure

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Intraoperative ventilator settings and acute lung injury after elective surgery : A nested case control study. / Fernández-Pérez, E. R.; Sprung, J.; Afessa, B.; Warner, David Oman; Vachon, Celine M; Schroeder, D. R.; Brown, D. R.; Hubmayr, R. D.; Gajic, Ognjen.

In: Thorax, Vol. 64, No. 2, 02.2009, p. 121-127.

Research output: Contribution to journalArticle

Fernández-Pérez, E. R. ; Sprung, J. ; Afessa, B. ; Warner, David Oman ; Vachon, Celine M ; Schroeder, D. R. ; Brown, D. R. ; Hubmayr, R. D. ; Gajic, Ognjen. / Intraoperative ventilator settings and acute lung injury after elective surgery : A nested case control study. In: Thorax. 2009 ; Vol. 64, No. 2. pp. 121-127.
@article{9b3b0f768ce345588618945a2a3a387f,
title = "Intraoperative ventilator settings and acute lung injury after elective surgery: A nested case control study",
abstract = "Background: While acute lung injury (ALI) is among the most serious postoperative pulmonary complications, its incidence, risk factors and outcome have not been prospectively studied. Objective: To determine the incidence and survival of ALI associated postoperative respiratory failure and its association with intraoperative ventilator settings, specifically tidal volume. Design: Prospective, nested, case control study. Setting: Single tertiary referral centre. Patients: 4420 consecutive patients without ALI undergoing high risk elective surgeries for postoperative pulmonary complications. Measurements: Incidence of ALI, survival and 2:1 matched case control comparison of intraoperative exposures. Results: 238 (5.4{\%}) patients developed postoperative respiratory failure. Causes included ALI in 83 (35{\%}), hydrostatic pulmonary oedema in 74 (31{\%}), shock in 27 (11.3{\%}), pneumonia in nine (4{\%}), carbon dioxide retention in eight (3.4{\%}) and miscellaneous in 37 (15{\%}). Compared with match controls (n = 166), ALI cases had lower 60 day and 1 year survival (99{\%} vs 73{\%} and 92{\%} vs 56{\%}; p<0.001). Cases were more likely to have a history of smoking, chronic obstructive pulmonary disease and diabetes, and to be exposed to longer duration of surgery, intraoperative hypotension and larger amount of fluid and transfusions. After adjustment for non-ventilator parameters, mean first hour peak airway pressure (OR 1.07; 95{\%} CI 1.02 to 1.15 cm H 2O) but not tidal volume (OR 1.03; 95{\%} CI 0.84 to 1.26 ml/kg), positive end expiratory pressure (OR 0.89; 95{\%} CI 0.77 to 1.04 cm H 2O) or fraction of inspired oxygen (OR 1.0; 95{\%} CI 0.98 to 1.03) were associated with ALI. Conclusion: ALI is the most common cause of postoperative respiratory failure and is associated with markedly lower postoperative survival. Intraoperative tidal volume was not associated with an increased risk for early postoperative ALI.",
author = "Fern{\'a}ndez-P{\'e}rez, {E. R.} and J. Sprung and B. Afessa and Warner, {David Oman} and Vachon, {Celine M} and Schroeder, {D. R.} and Brown, {D. R.} and Hubmayr, {R. D.} and Ognjen Gajic",
year = "2009",
month = "2",
doi = "10.1136/thx.2008.102228",
language = "English (US)",
volume = "64",
pages = "121--127",
journal = "Thorax",
issn = "0040-6376",
publisher = "BMJ Publishing Group",
number = "2",

}

TY - JOUR

T1 - Intraoperative ventilator settings and acute lung injury after elective surgery

T2 - A nested case control study

AU - Fernández-Pérez, E. R.

AU - Sprung, J.

AU - Afessa, B.

AU - Warner, David Oman

AU - Vachon, Celine M

AU - Schroeder, D. R.

AU - Brown, D. R.

AU - Hubmayr, R. D.

AU - Gajic, Ognjen

PY - 2009/2

Y1 - 2009/2

N2 - Background: While acute lung injury (ALI) is among the most serious postoperative pulmonary complications, its incidence, risk factors and outcome have not been prospectively studied. Objective: To determine the incidence and survival of ALI associated postoperative respiratory failure and its association with intraoperative ventilator settings, specifically tidal volume. Design: Prospective, nested, case control study. Setting: Single tertiary referral centre. Patients: 4420 consecutive patients without ALI undergoing high risk elective surgeries for postoperative pulmonary complications. Measurements: Incidence of ALI, survival and 2:1 matched case control comparison of intraoperative exposures. Results: 238 (5.4%) patients developed postoperative respiratory failure. Causes included ALI in 83 (35%), hydrostatic pulmonary oedema in 74 (31%), shock in 27 (11.3%), pneumonia in nine (4%), carbon dioxide retention in eight (3.4%) and miscellaneous in 37 (15%). Compared with match controls (n = 166), ALI cases had lower 60 day and 1 year survival (99% vs 73% and 92% vs 56%; p<0.001). Cases were more likely to have a history of smoking, chronic obstructive pulmonary disease and diabetes, and to be exposed to longer duration of surgery, intraoperative hypotension and larger amount of fluid and transfusions. After adjustment for non-ventilator parameters, mean first hour peak airway pressure (OR 1.07; 95% CI 1.02 to 1.15 cm H 2O) but not tidal volume (OR 1.03; 95% CI 0.84 to 1.26 ml/kg), positive end expiratory pressure (OR 0.89; 95% CI 0.77 to 1.04 cm H 2O) or fraction of inspired oxygen (OR 1.0; 95% CI 0.98 to 1.03) were associated with ALI. Conclusion: ALI is the most common cause of postoperative respiratory failure and is associated with markedly lower postoperative survival. Intraoperative tidal volume was not associated with an increased risk for early postoperative ALI.

AB - Background: While acute lung injury (ALI) is among the most serious postoperative pulmonary complications, its incidence, risk factors and outcome have not been prospectively studied. Objective: To determine the incidence and survival of ALI associated postoperative respiratory failure and its association with intraoperative ventilator settings, specifically tidal volume. Design: Prospective, nested, case control study. Setting: Single tertiary referral centre. Patients: 4420 consecutive patients without ALI undergoing high risk elective surgeries for postoperative pulmonary complications. Measurements: Incidence of ALI, survival and 2:1 matched case control comparison of intraoperative exposures. Results: 238 (5.4%) patients developed postoperative respiratory failure. Causes included ALI in 83 (35%), hydrostatic pulmonary oedema in 74 (31%), shock in 27 (11.3%), pneumonia in nine (4%), carbon dioxide retention in eight (3.4%) and miscellaneous in 37 (15%). Compared with match controls (n = 166), ALI cases had lower 60 day and 1 year survival (99% vs 73% and 92% vs 56%; p<0.001). Cases were more likely to have a history of smoking, chronic obstructive pulmonary disease and diabetes, and to be exposed to longer duration of surgery, intraoperative hypotension and larger amount of fluid and transfusions. After adjustment for non-ventilator parameters, mean first hour peak airway pressure (OR 1.07; 95% CI 1.02 to 1.15 cm H 2O) but not tidal volume (OR 1.03; 95% CI 0.84 to 1.26 ml/kg), positive end expiratory pressure (OR 0.89; 95% CI 0.77 to 1.04 cm H 2O) or fraction of inspired oxygen (OR 1.0; 95% CI 0.98 to 1.03) were associated with ALI. Conclusion: ALI is the most common cause of postoperative respiratory failure and is associated with markedly lower postoperative survival. Intraoperative tidal volume was not associated with an increased risk for early postoperative ALI.

UR - http://www.scopus.com/inward/record.url?scp=60549084757&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=60549084757&partnerID=8YFLogxK

U2 - 10.1136/thx.2008.102228

DO - 10.1136/thx.2008.102228

M3 - Article

C2 - 18988659

AN - SCOPUS:60549084757

VL - 64

SP - 121

EP - 127

JO - Thorax

JF - Thorax

SN - 0040-6376

IS - 2

ER -