Mechanical Power and the Association with Postoperative Impaired Oxygenation and Pulmonary Complications in Orthopedic Patients: Post Hoc Analysis of a Cluster Factorial Randomized Trial

作者：Lukas M. Müller‐Wirtz, Orkun Kopac, Adam Esa, Catalina Andrea Dussan Tovar, Mohammad Khudirat, Mehmet Akif Yazar, Alper Gulluoglu, Lu Wang, Kurt Ruetzler, Marcelo Gama de Abreu, Alparslan Turan · 发表于：Anesthesiology · 年份：2025 · DOI：10.1097/aln.0000000000005906 · 被引用次数：4 · 研究领域：Hemodynamic Monitoring and Therapy、Trauma and Emergency Care Studies、Respiratory Support and Mechanisms

BACKGROUND: Mechanical power-the energy transferred to the respiratory system per unit time-has been proposed as an overall indicator of ventilator-related harm. The authors therefore tested in this post hoc analysis of trial data whether intraoperative mechanical power normalized to predicted bodyweight is associated with impaired oxygenation in the postanesthesia care unit (PACU) or in the ward, postoperative pulmonary complications (PPCs), and length of postoperative hospital stay (LoS). METHODS: The original trial randomly assigned patients having orthopedic surgery to sequential factorial clusters of intraoperative ventilation with tidal volumes of 6 versus 10 ml/kg predicted bodyweight and a positive end-expiratory pressure of 5 versus 8 cm H 2 O, providing a wide range of exposure to mechanical power. The authors calculated the time-weighted mechanical power normalized to the predicted bodyweight for each patient included in the underlying trial and evaluated its association with the time-weighted average oxygen saturation measured by pulse oximetry/fraction of inspired oxygen ratio (SF-TWA) during the first hour of PACU stay, SF-TWA in the ward, PPCs, and LoS using a multivariable linear mixed model. They accounted for repeated surgeries and adjusted for demographic and intraoperative characteristics. RESULTS: The authors included 2,860 surgeries performed in 2,582 patients. Patients had a mean ± SD age of 63 ± 14 yr, were 53% female and 83% White; had a mean ± SD bod...