Driving Pressure during Thoracic Surgery

作者：MiHye Park, Hyun Joo Ahn, Jie Ae Kim, Mikyung Yang, Burn Young Heo, Ji Won Choi, Yung Ri Kim, Sang Hyun Lee, Heejoon Jeong, Soo Joo Choi, Insun Song · 发表于：Anesthesiology · 年份：2019 · DOI：10.1097/aln.0000000000002600 · 被引用次数：205 · 研究领域：Respiratory Support and Mechanisms、Travel-related health issues、Intensive Care Unit Cognitive Disorders

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Driving pressure (plateau minus end-expiratory airway pressure) is a target in patients with acute respiratory distress syndrome, and is proposed as a target during general anesthesia for patients with normal lungs. It has not been reported for thoracic anesthesia where isolated, inflated lungs may be especially at risk. WHAT THIS ARTICLE TELLS US THAT IS NEW: In a double-blinded, randomized trial (292 patients), minimized driving pressure compared with standard protective ventilation was associated with less postoperative pneumonia or acute respiratory distress syndrome. BACKGROUND: Recently, several retrospective studies have suggested that pulmonary complication is related with driving pressure more than any other ventilatory parameter. Thus, the authors compared driving pressure-guided ventilation with conventional protective ventilation in thoracic surgery, where lung protection is of the utmost importance. The authors hypothesized that driving pressure-guided ventilation decreases postoperative pulmonary complications more than conventional protective ventilation. METHODS: In this double-blind, randomized, controlled study, 292 patients scheduled for elective thoracic surgery were included in the analysis. The protective ventilation group (n = 147) received conventional protective ventilation during one-lung ventilation: tidal volume 6 ml/kg of ideal body weight, positive end-expiratory pressure (PEEP) 5 cm H2O, and recruitment man...