L Ball1, S N T Hemmes2, A Serpa Neto3, T Bluth4, J Canet5, M Hiesmayr6, M W Hollmann7, G H Mills8, M F Vidal Melo9, C Putensen10, W Schmid6, P Severgnini11, H Wrigge12, M Gama de Abreu4, M J Schultz13, P Pelosi14. 1. Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Policlinico San Martino, Genova, Italy; Department of Intensive Care, Amsterdam, The Netherlands. Electronic address: lorenzo.ball@edu.unige.it. 2. Department of Intensive Care, Amsterdam, The Netherlands; Department of Anaesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 3. Department of Intensive Care, Amsterdam, The Netherlands; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil. 4. Department of Anaesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. 5. Department of Anesthesiology and Postoperative Care, Hospital Universitari Germans Trias I Pujol, Barcelona, Spain. 6. Division Cardiac, Thoracic, Vascular Anesthesia and Intensive Care, Medical University Vienna, Vienna, Austria. 7. Department of Anaesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 8. Operating Services, Critical Care and Anaesthesia, Sheffield Teaching Hospitals and University of Sheffield, Sheffield, UK. 9. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA. 10. Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany. 11. Department of Biotechnology and Sciences of Life, ASST- Settelaghi Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy. 12. Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany. 13. Department of Intensive Care, Amsterdam, The Netherlands; Mahidol-Oxford Tropical Medicine Reseach Unit (MORU), Mahidol University, Bangkok, Thailand. 14. Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Policlinico San Martino, Genova, Italy.
Abstract
BACKGROUND: There is limited information concerning the current practice of intraoperative mechanical ventilation in obese patients, and the optimal ventilator settings for these patients are debated. We investigated intraoperative ventilation parameters and their associations with the development of postoperative pulmonary complications (PPCs) in obese patients. METHODS: We performed a secondary analysis of the international multicentre Local ASsessment of VEntilatory management during General Anesthesia for Surgery' (LAS VEGAS) study, restricted to obese patients, with a predefined composite outcome of PPCs as primary end-point. RESULTS: We analysed 2012 obese patients from 135 hospitals across 29 countries in Europe, North America, North Africa, and the Middle East. Tidal volume was 8.8 [25th-75th percentiles: 7.8-9.9] ml kg-1 predicted body weight, PEEP was 4 [1-5] cm H2O, and recruitment manoeuvres were performed in 7.7% of patients. PPCs occurred in 11.7% of patients and were independently associated with age (P<0.001), body mass index ≥40 kg m-2 (P=0.033), obstructive sleep apnoea (P=0.002), duration of anaesthesia (P<0.001), peak airway pressure (P<0.001), use of rescue recruitment manoeuvres (P<0.05) and routine recruitment manoeuvres performed by bag squeezing (P=0.021). PPCs were associated with an increased length of hospital stay (P<0.001). CONCLUSIONS: Obese patients are frequently ventilated with high tidal volume and low PEEP, and seldom receive recruitment manoeuvres. PPCs increase hospital stay, and are associated with preoperative conditions, duration of anaesthesia and intraoperative ventilation settings. Randomised trials are warranted to clarify the role of different ventilatory parameters in obese patients. CLINICAL TRIAL REGISTRATION: NCT01601223.
BACKGROUND: There is limited information concerning the current practice of intraoperative mechanical ventilation in obesepatients, and the optimal ventilator settings for these patients are debated. We investigated intraoperative ventilation parameters and their associations with the development of postoperative pulmonary complications (PPCs) in obesepatients. METHODS: We performed a secondary analysis of the international multicentre Local ASsessment of VEntilatory management during General Anesthesia for Surgery' (LAS VEGAS) study, restricted to obesepatients, with a predefined composite outcome of PPCs as primary end-point. RESULTS: We analysed 2012 obesepatients from 135 hospitals across 29 countries in Europe, North America, North Africa, and the Middle East. Tidal volume was 8.8 [25th-75th percentiles: 7.8-9.9] ml kg-1 predicted body weight, PEEP was 4 [1-5] cm H2O, and recruitment manoeuvres were performed in 7.7% of patients. PPCs occurred in 11.7% of patients and were independently associated with age (P<0.001), body mass index ≥40 kg m-2 (P=0.033), obstructive sleep apnoea (P=0.002), duration of anaesthesia (P<0.001), peak airway pressure (P<0.001), use of rescue recruitment manoeuvres (P<0.05) and routine recruitment manoeuvres performed by bag squeezing (P=0.021). PPCs were associated with an increased length of hospital stay (P<0.001). CONCLUSIONS:Obesepatients are frequently ventilated with high tidal volume and low PEEP, and seldom receive recruitment manoeuvres. PPCs increase hospital stay, and are associated with preoperative conditions, duration of anaesthesia and intraoperative ventilation settings. Randomised trials are warranted to clarify the role of different ventilatory parameters in obesepatients. CLINICAL TRIAL REGISTRATION: NCT01601223.
Authors: Lígia de A Maia; Marcos V S Fernandes; Raquel S Santos; Laís C Agra; Anna Carolinna Carvalho; Nazareth de N Rocha; Milena V Oliveira; Cíntia L Santos; Marcelo M Morales; Vera L Capelozzi; Sergio A L Souza; Bianca Gutfilen; Marcus J Schultz; Marcelo Gama de Abreu; Paolo Pelosi; Pedro L Silva; Patricia R M Rocco Journal: Front Physiol Date: 2019-12-17 Impact factor: 4.566
Authors: Christopher Uhlig; Ary Serpa Neto; Meta van der Woude; Thomas Kiss; Jakob Wittenstein; Benjamin Shelley; Helen Scholes; Michael Hiesmayr; Marcos Francisco Vidal Melo; Daniele Sances; Nesil Coskunfirat; Paolo Pelosi; Marcus Schultz; Marcelo Gama de Abreu Journal: BMC Anesthesiol Date: 2020-07-22 Impact factor: 2.217