Adjustments of Ventilator Parameters during Operating Room–to–ICU Transition and 28-Day Mortality
Dario von Wedel, Simone Redaelli, Aiman Suleiman, Luca J. Wachtendorf, Maxime Fosset, Peter Santer, Denys Shay, Ricardo Munoz‐Acuna, Guanqing Chen, Daniel Talmor, Boris Jung, Elias Baedorf Kassis, Maximilian S. Schaefer
Abstract
Abstract Rationale Lung-protective mechanical ventilation strategies have been proven beneficial in the operating room (OR) and the ICU. However, differential practices in ventilator management persist, often resulting in adjustments of ventilator parameters when transitioning patients from the OR to the ICU. Objectives To characterize patterns of ventilator adjustments during the transition of mechanically ventilated surgical patients from the OR to the ICU and assess their impact on 28-day mortality. Methods Hospital registry study including patients undergoing general anesthesia with continued, controlled mechanical ventilation in the ICU between 2008 and 2022. Ventilator parameters were assessed 1 hour before and 6 hours after the transition. Measurements and Main Results Of 2,103 patients, 212 (10.1%) died within 28 days. Upon OR-to-ICU transition, VT and driving pressure decreased (−1.1 ml/kg predicted body weight [IQR, −2.0 to −0.2]; P < 0.001; and −4.3 cm H2O [−8.2 to −1.2]; P < 0.001). Concomitantly, respiratory rates increased (+5.0 breaths/min [2.0 to 7.5]; P < 0.001), resulting overall in slightly higher mechanical power (MP) in the ICU (+0.7 J/min [−1.9 to 3.0]; P < 0.001). In adjusted analysis, increases in MP were associated with a higher 28-day mortality rate (adjusted odds ratio, 1.10; 95% confidence interval, 1.06–1.14; P < 0.001; adjusted risk difference, 0.7%; 95% confidence interval, 0.4–1.0, both per 1 J/min). Conclusion During transition of mechanically ventilated patients from the OR to the ICU, ventilator adjustments resulting in higher MP were associated with a greater risk of 28-day mortality.