The association of intraoperative low driving pressure ventilation and nonhome discharge: a historical cohort study

Tim M. Tartler, Luca J. Wachtendorf, Aiman Suleiman, Michael Blank, Elena Ahrens, Felix C. Linhardt, Friederike C. Althoff, Guanqing Chen, Peter Santer, Alexander Nagrebetsky, Matthias Eikermann, Maximilian S. Schaefer

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Purpose: To evaluate whether intraoperative ventilation using lower driving pressure decreases the risk of nonhome discharge. Methods: We conducted a historical cohort study of patients aged ≥ 60 yr who were living at home before undergoing elective, noncardiothoracic surgery at two tertiary healthcare networks in Massachusetts between 2007 and 2018. We assessed the association of the median driving pressure during intraoperative mechanical ventilation with nonhome discharge using multivariable logistic regression analysis, adjusted for patient and procedural factors. Contingent on the primary association, we assessed effect modification by patients’ baseline risk and mediation by postoperative respiratory failure. Results: Of 87,407 included patients, 12,584 (14.4%) experienced nonhome discharge. In adjusted analyses, a lower driving pressure was associated with a lower risk of nonhome discharge (adjusted odds ratio [aOR], 0.88; 95% confidence interval [CI], 0.83 to 0.93, per 10 cm H2O decrease; P < 0.001). This association was magnified in patients with a high baseline risk (aOR, 0.77; 95% CI, 0.73 to 0.81, per 10 cm H2O decrease, P-for-interaction < 0.001). The findings were confirmed in 19,518 patients matched for their baseline respiratory system compliance (aOR, 0.90; 95% CI, 0.81 to 1.00; P = 0.04 for low [< 15 cm H2O] vs high [≥ 15 cm H2O] driving pressures). A lower risk of respiratory failure mediated the association of a low driving pressure with nonhome discharge (20.8%; 95% CI, 15.0 to 56.8; P < 0.001). Conclusions: Intraoperative ventilation maintaining lower driving pressure was associated with a lower risk of nonhome discharge, which can be partially explained by lowered rates of postoperative respiratory failure. Future randomized controlled trials should target driving pressure as a potential intervention to decrease nonhome discharge.

Original languageEnglish (US)
Pages (from-to)359-373
Number of pages15
JournalCanadian Journal of Anesthesia
Volume70
Issue number3
DOIs
StatePublished - Mar 2023

Keywords

  • anesthesia
  • discharge disposition
  • lung-protective ventilation
  • mechanical ventilation
  • respiratory insufficiency

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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