目的:心脏外科手术患者术后肺部并发症经常发生,并与术后预后较差相关。驱动压力引导通气策略在减少肺部并发症方面的优势仍有待确定。我们旨在探讨术中驱动压力引导通气策略与常规肺保护性通气对体外循环心脏手术后肺部并发症的影响。
方法:前瞻性,双臂,随机对照试验。
方法:四川华西大学医院,中国。
方法:计划进行择期体外循环心脏手术的成年患者纳入研究。
方法:接受泵心脏手术的患者随机接受基于呼气末正压(PEEP)滴定的驱动压力引导通气策略或固定5cmH2O的常规肺保护性通气策略。
方法:肺部并发症(包括急性呼吸窘迫综合征,肺不张,肺炎,胸腔积液,和气胸)在术后前7天进行了前瞻性鉴定。次要结果包括肺部并发症的严重程度,ICU住院时间,以及住院和30天死亡率。
结果:在2020年8月至2021年7月之间,我们招募了694名符合条件的患者,这些患者被纳入最终分析。驱动压力组140例(40.3%)患者和常规组142例(40.9%)患者发生术后肺部并发症(相对危险度,0.99;95%置信区间,0.82-1.18;P=0.877)。意向治疗分析显示,在主要结局的发生率方面,研究组之间没有显着差异。驱动压力组肺不张的发生率低于常规组(11.5%vs17.0%;相对危险度,0.68;95%置信区间,0.47-0.98;P=0.039)。两组之间的次要结果没有差异。
结论:在接受体外循环心脏手术的患者中,与常规肺保护性通气策略相比,使用驱动压力引导通气策略并未降低术后肺部并发症的风险.
Postoperative pulmonary complications occur frequently and are associated with worse postoperative outcomes in cardiac surgical patients. The advantage of driving pressure-guided ventilation strategy in decreasing pulmonary complications remains to be definitively established. We aimed to investigate the effect of intraoperative driving pressure-guided ventilation strategy compared with conventional lung-protective ventilation on pulmonary complications following on-pump cardiac surgery.
Prospective, two-arm, randomized controlled trial.
The West
China university hospital in Sichuan,
China.
Adult patients who were scheduled for elective on-pump cardiac surgery were enrolled in the study.
Patients undergoing on-pump cardiac surgery were randomized to receive driving pressure-guided ventilation strategy based on positive end-expiratory pressure (PEEP) titration or conventional lung-protective ventilation strategy with fixed 5 cmH2O of PEEP.
The primary outcome of pulmonary complications (including acute respiratory distress syndrome, atelectasis, pneumonia, pleural effusion, and pneumothorax) within the first 7 postoperative days were prospectively identified. Secondary outcomes included pulmonary complication severity, ICU length of stay, and in-hospital and 30-day mortality.
Between August 2020 and July 2021, we enrolled 694 eligible patients who were included in the final analysis. Postoperative pulmonary complications occurred in 140 (40.3%) patients in the driving pressure group and 142 (40.9%) in the conventional group (relative risk, 0.99; 95% confidence interval, 0.82-1.18; P = 0.877). Intention-to-treat analysis showed no significant difference between study groups regarding the incidence of primary outcome. The driving pressure group had less atelectasis than the conventional group (11.5% vs 17.0%; relative risk, 0.68; 95% confidence interval, 0.47-0.98; P = 0.039). Secondary outcomes did not differ between groups.
Among patients who underwent on-pump cardiac surgery, the use of driving pressure-guided ventilation strategy did not reduce the risk of postoperative pulmonary complications when compared with conventional lung-protective ventilation strategy.