Browsing by Author "Goran Hedenstierna"

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    The Association of Intraoperative driving pressure with postoperative pulmonary complications in open versus closed abdominal surgery patients – a posthoc propensity score–weighted cohort analysis of the LAS VEGAS study
    (2021-12-01) Guido Mazzinari; Ary Serpa Neto; Sabrine N.T. Hemmes; Goran Hedenstierna; Samir Jaber; Michael Hiesmayr; Markus W. Hollmann; Gary H. Mills; Marcos F. Vidal Melo; Rupert M. Pearse; Christian Putensen; Werner Schmid; Paolo Severgnini; Hermann Wrigge; Oscar Diaz Cambronero; Lorenzo Ball; Marcelo Gama de Abreu; Paolo Pelosi; Marcus J. Schultz; Wolfgang Kroell; Helfried Metzler; Gerd Struber; Thomas Wegscheider; Hans Gombotz; Bernhard Urbanek; David Kahn; Mona Momeni; Audrey Pospiech; Fernande Lois; Patrice Forget; Irina Grosu; Jan Poelaert; Veerle van Mossevelde; Marie Claire van Malderen; Dimitri Dylst; Jeroen van Melkebeek; Maud Beran; Stefan de Hert; Luc De Baerdemaeker; Bjorn Heyse; Jurgen Van Limmen; Piet Wyffels; Tom Jacobs; Nathalie Roels; Ann De Bruyne; Stijn van de Velde; Brigitte Leva; Sandrine Damster; Benoit Plichon; Marina Juros-Zovko; Dejana Djonovic-Omanovic; Selma Pernar; Josip Zunic; Petar Miskovic; Antonio Zilic; Slavica Kvolik; Dubravka Ivic; Darija Azenic-Venzera; Sonja Skiljic; Hrvoje Vinkovic; Ivana Oputric; Kazimir Juricic; Vedran Frkovic; Jasminka Kopic; Ivan Mirkovic; Nenad Karanovic; Mladen Carev; Natasa Dropulic; Jadranka Pavicic Saric; Gorjana Erceg; Matea Bogdanovic Dvorscak; Branka Mazul-Sunko; Anna Marija Pavicic; Tanja Goranovic; Branka Maldini; Tomislav Radocaj; Zeljka Gavranovic; Inga Mladic-Batinica; Mirna Sehovic; Petr Stourac; Hana Harazim; Olga Smekalova; Martina Kosinova; Tomas Kolacek; Kamil Hudacek; Michal Drab; Jan Brujevic; Katerina Vitkova; Katerina Jirmanova; Ivana Volfova; Paula Dzurnakova; Katarina Liskova; Radovan Dudas; Radek Filipsky; Samir el Kafrawy; Hisham Hosny Abdelwahab; Tarek Metwally; Ahmed Abdel-Razek; Ahmed Mostafa El-Shaarawy; Wael Fathy Hasan; Université de Montpellier; IRCCS San Martino Polyclinic Hospital; Hospital Universitari i Politècnic La Fe; Universitätsklinikum Bonn; Massachusetts General Hospital; Università degli Studi di Genova; Queen Mary University of London; Technische Universität Dresden; Hospital Israelita Albert Einstein; Mahidol University; Medizinische Universität Wien; Nuffield Department of Medicine; Universidade de São Paulo; BG-Kliniken Bergmannstrost Halle; Università degli Studi dell'Insubria; Uppsala Universitet; The University of Sheffield; Amsterdam UMC - University of Amsterdam
    Background: It is uncertain whether the association of the intraoperative driving pressure (ΔP) with postoperative pulmonary complications (PPCs) depends on the surgical approach during abdominal surgery. Our primary objective was to determine and compare the association of time–weighted average ΔP (ΔPTW) with PPCs. We also tested the association of ΔPTW with intraoperative adverse events. Methods: Posthoc retrospective propensity score–weighted cohort analysis of patients undergoing open or closed abdominal surgery in the ‘Local ASsessment of Ventilatory management during General Anaesthesia for Surgery’ (LAS VEGAS) study, that included patients in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs. The secondary endpoint was a composite of intraoperative adverse events. Results: The analysis included 1128 and 906 patients undergoing open or closed abdominal surgery, respectively. The PPC rate was 5%. ΔP was lower in open abdominal surgery patients, but ΔPTW was not different between groups. The association of ΔPTW with PPCs was significant in both groups and had a higher risk ratio in closed compared to open abdominal surgery patients (1.11 [95%CI 1.10 to 1.20], P < 0.001 versus 1.05 [95%CI 1.05 to 1.05], P < 0.001; risk difference 0.05 [95%CI 0.04 to 0.06], P < 0.001). The association of ΔPTW with intraoperative adverse events was also significant in both groups but had higher odds ratio in closed compared to open abdominal surgery patients (1.13 [95%CI 1.12– to 1.14], P < 0.001 versus 1.07 [95%CI 1.05 to 1.10], P < 0.001; risk difference 0.05 [95%CI 0.030.07], P < 0.001). Conclusions: ΔP is associated with PPC and intraoperative adverse events in abdominal surgery, both in open and closed abdominal surgery. Trial registration: LAS VEGAS was registered at clinicaltrials.gov (trial identifier NCT01601223).
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    Potentially modifiable respiratory variables contributing to outcome in ICU patients without ARDS: a secondary analysis of PRoVENT
    (2018-12-01) Fabienne D. Simonis; Carmen S.V. Barbas; Antonio Artigas-Raventós; Jaume Canet; Rogier M. Determann; James Anstey; Goran Hedenstierna; Sabrine N.T. Hemmes; Greet Hermans; Michael Hiesmayr; Markus W. Hollmann; Samir Jaber; Ignacio Martin-Loeches; Gary H. Mills; Rupert M. Pearse; Christian Putensen; Werner Schmid; Paolo Severgnini; Roger Smith; Tanja A. Treschan; Edda M. Tschernko; Marcos F. Vidal Melo; Hermann Wrigge; Marcelo Gama de Abreu; Paolo Pelosi; Marcus J. Schultz; Ary Serpa Neto; Barry Dixon; Uniklinik Düsseldorf; KU Leuven– University Hospital Leuven; Universitäts-Klinikum Bonn und Medizinische Fakultät; Massachusetts General Hospital; Hospital Universitari Germans Trias i Pujol; Hopital Saint-Eloi; Dresden University Faculty of Medicine and University Hospital Carl Gustav Carus; Università degli Studi di Genova; KU Leuven; Barts and The London School of Medicine and Dentistry; Technische Universität Dresden; Hospital Israelita Albert Einstein; Mahidol University; Medizinische Universitat Wien; Trinity College Dublin; Hospital de Sabadell; Universidade de Sao Paulo - USP; Universität Leipzig; Università degli Studi dell'Insubria; Uppsala Universitet; St. Vincent's Hospital Melbourne; Amsterdam UMC - University of Amsterdam; Irish Centre for Vascular Biology; Sheffield Teaching Hospital
    © 2018, The Author(s). Background: The majority of critically ill patients do not suffer from acute respiratory distress syndrome (ARDS). To improve the treatment of these patients, we aimed to identify potentially modifiable factors associated with outcome of these patients. Methods: The PRoVENT was an international, multicenter, prospective cohort study of consecutive patients under invasive mechanical ventilatory support. A predefined secondary analysis was to examine factors associated with mortality. The primary endpoint was all-cause in-hospital mortality. Results: 935 Patients were included. In-hospital mortality was 21%. Compared to patients who died, patients who survived had a lower risk of ARDS according to the ‘Lung Injury Prediction Score’ and received lower maximum airway pressure (Pmax), driving pressure (ΔP), positive end-expiratory pressure, and FiO2 levels. Tidal volume size was similar between the groups. Higher Pmax was a potentially modifiable ventilatory variable associated with in-hospital mortality in multivariable analyses. ΔP was not independently associated with in-hospital mortality, but reliable values for ΔP were available for 343 patients only. Non-modifiable factors associated with in-hospital mortality were older age, presence of immunosuppression, higher non-pulmonary sequential organ failure assessment scores, lower pulse oximetry readings, higher heart rates, and functional dependence. Conclusions: Higher Pmax was independently associated with higher in-hospital mortality in mechanically ventilated critically ill patients under mechanical ventilatory support for reasons other than ARDS. Trial Registration ClinicalTrials.gov (NCT01868321).
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    Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study
    (2021-10-01) Sunny G. Nijbroek; Liselotte Hol; Pien Swart; Sabrine N.T. Hemmes; Ary Serpa Neto; Jan M. Binnekade; Goran Hedenstierna; Samir Jaber; Michael Hiesmayr; Markus W. Hollmann; Gary H. Mills; Marcos F. Vidal Melo; Christian Putensen; Werner Schmid; Paolo Severgnini; Hermann Wrigge; Marcelo Gama de Abreu; Paolo Pelosi; Marcus J. Schultz; Monash University
    BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients. OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference. DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries. MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation. RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT. CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV. TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223.