Effects of Driving Pressure-Guided Ventilation on Postoperative Pulmonary Complications in Prone-Positioned Patients Undergoing Spinal Surgery: A Randomized Controlled Clinical Trial
Background Prolonged spinal surgery in the prone position may lead to postoperative pulmonary complications (PPCs). We aimed to compare the effects of driving pressure-guided ventilation versus conventional protective ventilation on postoperative pulmonary complications in patients undergoing spinal...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2022-10-01
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| Series: | Journal of Investigative Surgery |
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| Online Access: | http://dx.doi.org/10.1080/08941939.2022.2107250 |
| _version_ | 1797684446184341504 |
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| author | Di Jin Huayue Liu Xiaoqi Kong Guangle Wei Ke Peng Hao Cheng Fuhai Ji |
| author_facet | Di Jin Huayue Liu Xiaoqi Kong Guangle Wei Ke Peng Hao Cheng Fuhai Ji |
| author_sort | Di Jin |
| collection | DOAJ |
| description | Background Prolonged spinal surgery in the prone position may lead to postoperative pulmonary complications (PPCs). We aimed to compare the effects of driving pressure-guided ventilation versus conventional protective ventilation on postoperative pulmonary complications in patients undergoing spinal surgery in the prone position. We hypothesized that driving pressure-guided ventilation would be associated with a decreased incidence of PPC. Methods We enrolled 78 patients into this single-center, double-blind, randomized controlled trial. The driving pressure (DP) group (n = 40) received a tidal volume of 6 ml/kg of predicted body weight, individualized positive end-expiratory pressure (PEEP) which produced the lowest driving pressure (plateau pressure-PEEP), and a recruitment maneuver. The protective ventilation (PV) group (n = 38) received the same tidal volume and recruitment maneuver but with a fixed PEEP of 5 cm H2O. Our primary outcome was postoperative pulmonary complications based on Lung Ultrasound Scores (LUS) at the end of the surgery and the simplified Clinical Pulmonary Infection Score (sCPIS) on postoperative days (POD) 1 and 3. Results DP patients had lower LUS and POD1 sCPIS than the PV group (p < 0.01). DP patients had lower driving pressure during the surgery than PV patients (p < 0.01). Perioperative arterial blood gases and hemodynamic parameters were comparable between the two groups (p > 0.05). The visual pain score (VAS) in postoperative days, drainage, and lengths of stay (LOS) were also similar between the two groups (p > 0.05). Conclusions Driving pressure-guided ventilation during spinal surgery with a prolonged prone patient position may reduce the incidence of early postoperative pulmonary complications, compared with conventional protective ventilation. |
| first_indexed | 2024-03-12T00:29:45Z |
| format | Article |
| id | doaj.art-074aead484a742d9bb5cf293078b43a8 |
| institution | Directory Open Access Journal |
| issn | 0894-1939 1521-0553 |
| language | English |
| last_indexed | 2024-03-12T00:29:45Z |
| publishDate | 2022-10-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Journal of Investigative Surgery |
| spelling | doaj.art-074aead484a742d9bb5cf293078b43a82023-09-15T10:21:30ZengTaylor & Francis GroupJournal of Investigative Surgery0894-19391521-05532022-10-0135101754176010.1080/08941939.2022.21072502107250Effects of Driving Pressure-Guided Ventilation on Postoperative Pulmonary Complications in Prone-Positioned Patients Undergoing Spinal Surgery: A Randomized Controlled Clinical TrialDi Jin0Huayue Liu1Xiaoqi Kong2Guangle Wei3Ke Peng4Hao Cheng5Fuhai Ji6Department of Anesthesiology, The First Affiliated Hospital of Soochow UniversityDepartment of Anesthesiology, The First Affiliated Hospital of Soochow UniversityDepartment of Anesthesiology, The First Affiliated Hospital of Soochow UniversityInstitute of Anesthesiology, Soochow UniversityDepartment of Anesthesiology, The First Affiliated Hospital of Soochow UniversityDepartment of Anesthesiology, The First Affiliated Hospital of Soochow UniversityDepartment of Anesthesiology, The First Affiliated Hospital of Soochow UniversityBackground Prolonged spinal surgery in the prone position may lead to postoperative pulmonary complications (PPCs). We aimed to compare the effects of driving pressure-guided ventilation versus conventional protective ventilation on postoperative pulmonary complications in patients undergoing spinal surgery in the prone position. We hypothesized that driving pressure-guided ventilation would be associated with a decreased incidence of PPC. Methods We enrolled 78 patients into this single-center, double-blind, randomized controlled trial. The driving pressure (DP) group (n = 40) received a tidal volume of 6 ml/kg of predicted body weight, individualized positive end-expiratory pressure (PEEP) which produced the lowest driving pressure (plateau pressure-PEEP), and a recruitment maneuver. The protective ventilation (PV) group (n = 38) received the same tidal volume and recruitment maneuver but with a fixed PEEP of 5 cm H2O. Our primary outcome was postoperative pulmonary complications based on Lung Ultrasound Scores (LUS) at the end of the surgery and the simplified Clinical Pulmonary Infection Score (sCPIS) on postoperative days (POD) 1 and 3. Results DP patients had lower LUS and POD1 sCPIS than the PV group (p < 0.01). DP patients had lower driving pressure during the surgery than PV patients (p < 0.01). Perioperative arterial blood gases and hemodynamic parameters were comparable between the two groups (p > 0.05). The visual pain score (VAS) in postoperative days, drainage, and lengths of stay (LOS) were also similar between the two groups (p > 0.05). Conclusions Driving pressure-guided ventilation during spinal surgery with a prolonged prone patient position may reduce the incidence of early postoperative pulmonary complications, compared with conventional protective ventilation.http://dx.doi.org/10.1080/08941939.2022.2107250driving pressureprotective ventilationpulmonary complicationsprone positionspinal surgery |
| spellingShingle | Di Jin Huayue Liu Xiaoqi Kong Guangle Wei Ke Peng Hao Cheng Fuhai Ji Effects of Driving Pressure-Guided Ventilation on Postoperative Pulmonary Complications in Prone-Positioned Patients Undergoing Spinal Surgery: A Randomized Controlled Clinical Trial Journal of Investigative Surgery driving pressure protective ventilation pulmonary complications prone position spinal surgery |
| title | Effects of Driving Pressure-Guided Ventilation on Postoperative Pulmonary Complications in Prone-Positioned Patients Undergoing Spinal Surgery: A Randomized Controlled Clinical Trial |
| title_full | Effects of Driving Pressure-Guided Ventilation on Postoperative Pulmonary Complications in Prone-Positioned Patients Undergoing Spinal Surgery: A Randomized Controlled Clinical Trial |
| title_fullStr | Effects of Driving Pressure-Guided Ventilation on Postoperative Pulmonary Complications in Prone-Positioned Patients Undergoing Spinal Surgery: A Randomized Controlled Clinical Trial |
| title_full_unstemmed | Effects of Driving Pressure-Guided Ventilation on Postoperative Pulmonary Complications in Prone-Positioned Patients Undergoing Spinal Surgery: A Randomized Controlled Clinical Trial |
| title_short | Effects of Driving Pressure-Guided Ventilation on Postoperative Pulmonary Complications in Prone-Positioned Patients Undergoing Spinal Surgery: A Randomized Controlled Clinical Trial |
| title_sort | effects of driving pressure guided ventilation on postoperative pulmonary complications in prone positioned patients undergoing spinal surgery a randomized controlled clinical trial |
| topic | driving pressure protective ventilation pulmonary complications prone position spinal surgery |
| url | http://dx.doi.org/10.1080/08941939.2022.2107250 |
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