Association of plasma biomarkers of lung injury with positive end expiratory pressure and postoperative pulmonary complications in obese surgical patients: A substudy of the PROBESE randomised controlled trial
2
Issued Date
2025-01-01
Resource Type
ISSN
02650215
eISSN
13652346
Scopus ID
2-s2.0-105010046973
Pubmed ID
40548583
Journal Title
European Journal of Anaesthesiology
Rights Holder(s)
SCOPUS
Bibliographic Citation
European Journal of Anaesthesiology (2025)
Suggested Citation
Bluth T., Rivas E., López-Baamonde M., Sanahuja J.M., López-Hernández A., Balust J., Weingarten T.N., Girrbach F., Simon P., Wrigge H., Wittenstein J., Birr K., Teichmann R., Huhle R., Melchior N., Vivona L., Koch T., Ramakrishna H., Brull S., Serpa Neto A., Schultz M.J., Sprung J., Scharffenberg M., Gama De Abreu M., Bluth T., Bobek I., Canet J.C., Cinella G., Baerdemaeker L.d., Gregoretti C., Hedenstierna G., Hemmes S.N.T., Hiesmayr M., Hollmann W., Jaber S., Laffey J., Licker M.J., Markstaller K., Matot I., Mills G.H., Mulier J.P., Putensen C., Rossaint R., Schmitt J., Senturk M., Severgnini P., Sprung J., Melo M.F.V., Wrigge H., Neto A.S., Schultz M.J., Pelosi P., Abreu M.G.d. Association of plasma biomarkers of lung injury with positive end expiratory pressure and postoperative pulmonary complications in obese surgical patients: A substudy of the PROBESE randomised controlled trial. European Journal of Anaesthesiology (2025). doi:10.1097/EJA.0000000000002221 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/111250
Title
Association of plasma biomarkers of lung injury with positive end expiratory pressure and postoperative pulmonary complications in obese surgical patients: A substudy of the PROBESE randomised controlled trial
Author(s)
Bluth T.
Rivas E.
López-Baamonde M.
Sanahuja J.M.
López-Hernández A.
Balust J.
Weingarten T.N.
Girrbach F.
Simon P.
Wrigge H.
Wittenstein J.
Birr K.
Teichmann R.
Huhle R.
Melchior N.
Vivona L.
Koch T.
Ramakrishna H.
Brull S.
Serpa Neto A.
Schultz M.J.
Sprung J.
Scharffenberg M.
Gama De Abreu M.
Bluth T.
Bobek I.
Canet J.C.
Cinella G.
Baerdemaeker L.d.
Gregoretti C.
Hedenstierna G.
Hemmes S.N.T.
Hiesmayr M.
Hollmann W.
Jaber S.
Laffey J.
Licker M.J.
Markstaller K.
Matot I.
Mills G.H.
Mulier J.P.
Putensen C.
Rossaint R.
Schmitt J.
Senturk M.
Severgnini P.
Sprung J.
Melo M.F.V.
Wrigge H.
Neto A.S.
Schultz M.J.
Pelosi P.
Abreu M.G.d.
Rivas E.
López-Baamonde M.
Sanahuja J.M.
López-Hernández A.
Balust J.
Weingarten T.N.
Girrbach F.
Simon P.
Wrigge H.
Wittenstein J.
Birr K.
Teichmann R.
Huhle R.
Melchior N.
Vivona L.
Koch T.
Ramakrishna H.
Brull S.
Serpa Neto A.
Schultz M.J.
Sprung J.
Scharffenberg M.
Gama De Abreu M.
Bluth T.
Bobek I.
Canet J.C.
Cinella G.
Baerdemaeker L.d.
Gregoretti C.
Hedenstierna G.
Hemmes S.N.T.
Hiesmayr M.
Hollmann W.
Jaber S.
Laffey J.
Licker M.J.
Markstaller K.
Matot I.
Mills G.H.
Mulier J.P.
Putensen C.
Rossaint R.
Schmitt J.
Senturk M.
Severgnini P.
Sprung J.
Melo M.F.V.
Wrigge H.
Neto A.S.
Schultz M.J.
Pelosi P.
Abreu M.G.d.
Author's Affiliation
Monash University
Università degli Studi di Milano
Mayo Clinic
Cleveland Clinic Foundation
Amsterdam UMC - University of Amsterdam
Medizinische Universität Wien
Universität Leipzig
Hospital Clínic de Barcelona
Mayo Clinic in Jacksonville, Florida
Mayo Clinic Scottsdale-Phoenix, Arizona
Nuffield Department of Medicine
Universitätsklinikum Carl Gustav Carus Dresden
Universität Augsburg
Hospital Israelita Albert Einstein
Melbourne Medical School
Mahidol Oxford Tropical Medicine Research Unit
BG-Kliniken Bergmannstrost Halle
Università degli Studi di Milano
Mayo Clinic
Cleveland Clinic Foundation
Amsterdam UMC - University of Amsterdam
Medizinische Universität Wien
Universität Leipzig
Hospital Clínic de Barcelona
Mayo Clinic in Jacksonville, Florida
Mayo Clinic Scottsdale-Phoenix, Arizona
Nuffield Department of Medicine
Universitätsklinikum Carl Gustav Carus Dresden
Universität Augsburg
Hospital Israelita Albert Einstein
Melbourne Medical School
Mahidol Oxford Tropical Medicine Research Unit
BG-Kliniken Bergmannstrost Halle
Corresponding Author(s)
Other Contributor(s)
Abstract
BACKGROUND The effect of positive end expiratory pressure (PEEP) on postoperative pulmonary complications (PPCs) in obese patients remains controversial. OBJECTIVE To test, whether intra-operative PEEP or PPCs are associated with plasma levels of biomarkers of lung injury. DESIGN A prospective substudy of a multicentre randomised controlled trial (PROBESE). SETTING Operating rooms of six tertiary care centres in the United States and Europe. PATIENTS Obese patients at risk for PPCs undergoing abdominal surgery. INTERVENTION Intra-operative low tidal volume ventilation with high PEEP (12 cmH2O) and recruitment manoeuvres, or low PEEP (4 cmH2O). MAIN OUTCOME MEASURES The primary endpoint was the association between absolute postoperative plasma levels of receptor for advanced glycation end-products (RAGE) and intra-operative PEEP; secondary endpoints included pre and postoperative plasma concentrations as well as the relative changes of interleukin-6, IL-8, tumour necrosis factor-α, surfactant protein D, mucin-1, clara cell protein-16, intercellular adhesion molecule-1 and vascular cell adhesion molecule. PPCs were assessed as a 'collapsed composite' of adverse pulmonary events. The predictive ability of biomarkers for PPCs was assessed with the receiver operating curve-area under the curve (ROC-AUC). RESULTS A total of 96 patients received low PEEP, and 95 patients high PEEP. Postoperative plasma concentrations of RAGE and other biomarkers did not differ between groups. The relative increase of RAGE during surgery was more pronounced with low than high PEEP; median [IQR], 1.2 [1.0 to 1.6] vs. 1.1 [0.9 to 1.3], P = 0.012. Patients who developed PPCs showed higher postoperative plasma levels and relative increase of IL-6; 26.3 [12.6 to 139.5] vs. 15.1 [3.7 to 38.7] fold change. The ROC-AUC was less than 0.7 for all biomarkers. CONCLUSIONS In this subgroup, choice of PEEP did not affect postoperative biomarkers of lung injury. Irrespective of PEEP, PPCs were associated with an increase in plasma levels of these biomarkers, but their predictive capability was poor.