Low intraoperative tidal volume ventilation with minimal PEEP is associated with increased mortality M. A. Levin1, P. J. McCormick1, H. M. Lin1,2, L. Hosseinian1 and G. W. Fischer1,3* 1 Department of Anesthesiology, 2 Department of Health Evidence and Policy, and 3 Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1010, New York, NY 10029, USA † Low tidal volume (TV)ventilation (5–8 ml kg21) withPEEP is of established benefit aspart of ‘lung protection’ in ICUpatients with acute lung injury.† However, the advantages inpatients undergoing surgeryare not established.† In this large retrospective study, ventilation using low TVsand minimal PEEP was associated with increases in30-day mortality and length of hospital stay.† This suggests that ventilationusing low TV alone might beharmful, and low TVs arebeneficial only when used with PEEP.† More prospective data arerequired to confirm these findings.Background. Anaesthetists have traditionally ventilated patients’ lungs with tidalvolumes (TVs) between 10 and 15 ml kg21 of ideal body weight (IBW), without the useof PEEP. Over the past decade, influenced by the results of the Acute Respiratory Distress Syndrome Network trial, many anaesthetists have begun using lower TVsduring surgery. It is unclear whether the benefits of low TV ventilation can be extendedinto the perioperative period. Methods. We reviewed the records of 29 343 patients who underwent generalanaesthesia with mechanical ventilation between January 1, 2008 and December 31,2011. We calculated TV kg21 IBW, PEEP, peak inspiratory pressure (PIP), and dynamic compliance. Cox regression analysis with propensity score matching was performed toexamine the association between TV and 30-day mortality. Results. Median TV was 8.6 [7.7 –9.6] ml kg21 IBW with minimal PEEP [4.0 (2.2–5.0) cmH2O]. A significant reduction in TV occurred over the study period, from 9 ml kg21 IBWin 2008 to 8.3 ml kg21 IBW in 2011 (P¼0.01). Low TV 6–8 ml kg21 IBW was associated with a significant increase in 30-day mortality vs TV 8–10 ml kg21 IBW: hazard ratio(HR) 1.6 [95% confidence interval (CI) [1.25–2.08], P¼0.0002]. The associationremained significant after matching: HR 1.63 [95% CI (1.22–2.18), P,0.001]. There wasonly a weak correlation between TV kg21 IBW and dynamic compliance (r¼20.006,P¼0.31) and a weak-to-moderate correlation between TV kg21 IBW and PIP (r¼0.32P,0.0001). Conclusions. Use of low intraoperative TV with minimal PEEP is associated with anincreased risk of 30-day mortality
Posted on: Tue, 29 Jul 2014 01:13:02 +0000
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