Driving pressure-guided ventilation and postoperative pulmonary complications in thoracic surgery: a multicentre randomised clinical trial
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, Jae-Hyon Bahk, Juyoun Kim, Sang-Ho Lee, In‐Cheol Choi, Young Jun Oh, Wonjung Hwang, Byung Gun Lim, Burn Young Heo
Abstract
Background: 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. Methods: In this multicentre trial, patients undergoing lung resection surgery were randomised to either a driving pressure group (n650) receiving an alveolar recruitment/individualised PEEP to deliver the lowest driving pressure or to a conventional protective ventilation group (n650) with fixed PEEP of 5 cm H 2 O. The primary outcome was a composite of pulmonary complications within 7 days postoperatively. Results: 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 H 2 O in the driving pressure group vs 9.2 cm H 2 O in the protective ventilation group (mean difference [95% confidence interval, CI]; 2.1 [2.4 to 1.9] cm H 2 O; 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%; P0.42). Intraoperatively, lung compliance (mean [SD], 42.7 [12.4] vs 33.5 [11.1] ml cm H 2 O 1 ; P<0.001) and Pa o2 (median [inter-quartile range], 21.5 [14.5 to 30.4] vs