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Title: Intraoperative ventilation settings and their associations with postoperative pulmonary complications in obese patients
Authors: L. Ball
S. N.T. Hemmes
A. Serpa Neto
T. Bluth
J. Canet
M. Hiesmayr
M. W. Hollmann
G. H. Mills
M. F. Vidal Melo
C. Putensen
W. Schmid
P. Severgnini
H. Wrigge
M. Gama de Abreu
M. J. Schultz
P. Pelosi
Ospedale Policlinico San Martino
Universitäts-Klinikum Bonn und Medizinische Fakultät
Massachusetts General Hospital
Hospital Universitari Germans Trias i Pujol
Dresden University Faculty of Medicine and University Hospital Carl Gustav Carus
Sheffield Teaching Hospitals NHS Foundation Trust
Hospital Israelita Albert Einstein
Mahidol University
Medizinische Universitat Wien
Universität Leipzig
Università degli Studi dell'Insubria
Amsterdam UMC - University of Amsterdam
Keywords: Medicine
Issue Date: 1-Oct-2018
Citation: British Journal of Anaesthesia. Vol.121, No.4 (2018), 899-908
Abstract: © 2018 British Journal of Anaesthesia 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 [25 th –75 th percentiles: 7.8–9.9] ml kg −1 predicted body weight, PEEP was 4 [1–5] cm H 2 O, 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.
ISSN: 14716771
Appears in Collections:Scopus 2018

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