TY - JOUR
T1 - Mechanical Power during General Anesthesia and Postoperative Respiratory Failure
T2 - A Multicenter Retrospective Cohort Study
AU - Santer, Peter
AU - Wachtendorf, Luca J.
AU - Suleiman, Aiman
AU - Houle, Timothy T.
AU - Fassbender, Philipp
AU - Costa, Eduardo L.
AU - Talmor, Daniel
AU - Eikermann, Matthias
AU - Baedorf-Kassis, Elias
AU - Schaefer, Maximilian S.
N1 - Funding Information:
Dr. Houle has indicated financial relationships outside the submitted work with the American Society of Anesthesiologists (Schaumburg, Illinois) and the American Headache Society (Royal, New Jersey). Dr. Costa has received consulting fees from Timpel S.A. (São Paulo, Brazil), Magnamed S.A. (São Paulo, Brazil), and Getinge (Gothenburg, Sweden), outside the submitted work. Dr. Talmor received speaking fees and grant funds from Hamilton Medical, Inc. (Bonaduz, Switzerland), outside the submitted work. Dr. Baedorf-Kassis has received lecturing fees from Hamilton Medical, Inc., outside the submitted work and has received a KL2 award from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health award No. KL2 TR002542). The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic healthcare centers, or the National Institutes of Health. Dr. Eikermann has received unrestricted funds from philanthropic donors Jeffrey and Judy Buzen during the conduct of the study, has received grants for investigator-initiated trials not related to this article from Merck & Co. (Kenilworth, New Jersey), and serves as a consultant on the advisory board of Merck & Co. Dr. Schaefer has received a grant for investigator-initiated trials not related to this article from Merck & Co. The other authors declare no competing interests.
Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2022/7/1
Y1 - 2022/7/1
N2 - Background: Mechanical power during ventilation estimates the energy delivered to the respiratory system through integrating inspiratory pressures, tidal volume, and respiratory rate into a single value. It has been linked to lung injury and mortality in the acute respiratory distress syndrome, but little evidence exists regarding whether the concept relates to lung injury in patients with healthy lungs. This study hypothesized that higher mechanical power is associated with greater postoperative respiratory failure requiring reintubation in patients undergoing general anesthesia. Methods: In this multicenter, retrospective study, 230,767 elective, noncardiac adult surgical out- and inpatients undergoing general anesthesia between 2008 and 2018 at two academic hospital networks in Boston, Massachusetts, were included. The risk-adjusted association between the median intraoperative mechanical power, calculated from median values of tidal volume (Vt), respiratory rate (RR), positive end-expiratory pressure (PEEP), plateau pressure (Pplat), and peak inspiratory pressure (Ppeak), using the following formula: mechanical power (J/min) = 0.098 × RR × Vt× (PEEP + ½[Pplat- PEEP] + [Ppeak- Pplat]), and postoperative respiratory failure requiring reintubation within 7 days, was assessed. Results: The median intraoperative mechanical power was 6.63 (interquartile range, 4.62 to 9.11) J/min. Postoperative respiratory failure occurred in 2,024 (0.9%) patients. The median (interquartile range) intraoperative mechanical power was higher in patients with postoperative respiratory failure than in patients without (7.67 [5.64 to 10.11] vs. 6.62 [4.62 to 9.10] J/min; P < 0.001). In adjusted analyses, a higher mechanical power was associated with greater odds of postoperative respiratory failure (adjusted odds ratio, 1.31 per 5 J/min increase; 95% CI, 1.21 to 1.42; P < 0.001). The association between mechanical power and postoperative respiratory failure was robust to additional adjustment for known drivers of ventilator-induced lung injury, including tidal volume, driving pressure, and respiratory rate, and driven by the dynamic elastic component (adjusted odds ratio, 1.35 per 5 J/min; 95% CI, 1.05 to 1.73; P = 0.02). Conclusions: Higher mechanical power during ventilation is statistically associated with a greater risk of postoperative respiratory failure requiring reintubation.
AB - Background: Mechanical power during ventilation estimates the energy delivered to the respiratory system through integrating inspiratory pressures, tidal volume, and respiratory rate into a single value. It has been linked to lung injury and mortality in the acute respiratory distress syndrome, but little evidence exists regarding whether the concept relates to lung injury in patients with healthy lungs. This study hypothesized that higher mechanical power is associated with greater postoperative respiratory failure requiring reintubation in patients undergoing general anesthesia. Methods: In this multicenter, retrospective study, 230,767 elective, noncardiac adult surgical out- and inpatients undergoing general anesthesia between 2008 and 2018 at two academic hospital networks in Boston, Massachusetts, were included. The risk-adjusted association between the median intraoperative mechanical power, calculated from median values of tidal volume (Vt), respiratory rate (RR), positive end-expiratory pressure (PEEP), plateau pressure (Pplat), and peak inspiratory pressure (Ppeak), using the following formula: mechanical power (J/min) = 0.098 × RR × Vt× (PEEP + ½[Pplat- PEEP] + [Ppeak- Pplat]), and postoperative respiratory failure requiring reintubation within 7 days, was assessed. Results: The median intraoperative mechanical power was 6.63 (interquartile range, 4.62 to 9.11) J/min. Postoperative respiratory failure occurred in 2,024 (0.9%) patients. The median (interquartile range) intraoperative mechanical power was higher in patients with postoperative respiratory failure than in patients without (7.67 [5.64 to 10.11] vs. 6.62 [4.62 to 9.10] J/min; P < 0.001). In adjusted analyses, a higher mechanical power was associated with greater odds of postoperative respiratory failure (adjusted odds ratio, 1.31 per 5 J/min increase; 95% CI, 1.21 to 1.42; P < 0.001). The association between mechanical power and postoperative respiratory failure was robust to additional adjustment for known drivers of ventilator-induced lung injury, including tidal volume, driving pressure, and respiratory rate, and driven by the dynamic elastic component (adjusted odds ratio, 1.35 per 5 J/min; 95% CI, 1.05 to 1.73; P = 0.02). Conclusions: Higher mechanical power during ventilation is statistically associated with a greater risk of postoperative respiratory failure requiring reintubation.
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U2 - 10.1097/ALN.0000000000004256
DO - 10.1097/ALN.0000000000004256
M3 - Article
C2 - 35475882
AN - SCOPUS:85131770359
VL - 137
SP - 41
EP - 54
JO - Anesthesiology
JF - Anesthesiology
SN - 0003-3022
IS - 1
ER -