EAJAIC
Eurasian Journal of Anesthesiology and Intensive Care

The Eurasian Journal of Anesthesiology and Intensive Care (EAJAIC) is an independent-unbiased, peer-reviewed, "double-blind", and open-access journal of current national and international issues and reviews for original clinical and experimental research, interesting case reports, differential diagnoses, editorial opinions, letters to the editor, and educational papers in anesthesiology, algology, and intensive care medicine.

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Original Article
Mechanical power and postoperative pulmonary complications in patients undergoing major abdominal surgery
Abstract
Aims: Postoperative pulmonary complications (PPCs) are a major cause of perioperative morbidity and mortality in patients undergoing major abdominal surgery. Although various factors contribute to PPCs, intraoperative mechanical ventilation strategies play a critical role. Mechanical power, a parameter encompassing factors like tidal volume and respiratory rate, has emerged as a potential risk factor for ventilator-associated lung injury (VILI). This study aims to investigate the relationship between intraoperative mechanical power and PPCs.
Methods: This prospective, observational study included 207 patients aged 18 years and older undergoing elective major abdominal surgery between April and December 2022. Mechanical power was calculated using a simplified formula based on ventilator parameters recorded at 15-minute intervals. PPCs were evaluated within 24 hours postoperatively, following the European Perioperative Clinical Outcome guidelines. Primary outcome was the relationship between intraoperative mechanical power and PPCs, with secondary outcomes assessing the incidence of specific PPCs.
Results: PPCs occurred in 22.2% (n=46) of the patients. The mean mechanical power was 8.99 J/min in patients with PPCs and 8.56 J/min in those without, with no statistically significant difference. Atelectasis was the most common PPC. Factors such as chronic obstructive pulmonary disease, prolonged surgery, and higher ASA scores were associated with increased PPC risk.
Conclusion: Although no significant association between mechanical power and PPCs was found in this study, the findings underscore the importance of considering mechanical power in intraoperative ventilation strategies to reduce the risk of ventilator-associated lung injury. Further large-scale, prospective studies involving diverse patient populations are essential to clarify the role of mechanical power in minimizing PPCs and improving perioperative outcomes. Careful selection and management of ventilation strategies, with a focus on optimizing mechanical power, remain crucial in reducing PPC incidence and enhancing patient care.

Keywords : Lung injury, ventilators-mechanical, perioperative care, ventilator-induced lung injury

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1. Patel K, Hadian F, Ali A, et al. Postoperative pulmonary complications following major elective abdominal surgery: a cohort study. <em>Perioperative Med</em>. 2016;5(1):10. doi:10.1186/s13741-016-0037-0
2. Weiser TG, Regenbogen SE, Thompson KD, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. <em>Lancet</em>. 2008;372(9633):139-144. doi:10.1016/S0140-6736(08)60878-8
3. Khan NA, Quan H, Bugar JM, Lemaire JB, Brant R, Ghali WA. Association of postoperative complications with hospital costs and length of stay in a tertiary care center. <em>J Gen Intern Med</em>. 2006;21(2):177-180. doi:10.1111/j.1525-1497.2006.00319.x
4. Miskovic A, Lumb AB. Postoperative pulmonary complications. <em>Br J Anaesth</em>. 2017;118(3):317-334. doi:10.1093/bja/aex002
5. Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures. <em>Eur J Anaesthesiol</em>. 2015;32(2):88-105. doi:10.1097/EJA.0000000000000118
6. Shander A, Fleisher LA, Barie PS, Bigatello LM, Sladen RN, Watson CB. Clinical and economic burden of postoperative pulmonary complications: patient safety summit on definition, risk-reducing interventions, and preventive strategies. <em>Crit Care Med</em>. 2011;39(9):2163-2172. doi:10.1097/CCM.0b013e31821f0522
7. Gattinoni L, Tonetti T, Cressoni M, et al. Ventilator-related causes of lung injury: the mechanical power. <em>Intensive Care Med</em>. 2016;42(10):1567-1575. doi:10.1007/s00134-016-4505-2
8. Giosa L, Busana M, Pasticci I, et al. Mechanical power at a glance: a simple surrogate for volume-controlled ventilation. <em>Intensive Care Med Exp</em>. 2019;7(1):61. doi:10.1186/s40635-019-0276-8
9. Cressoni M, Gotti M, Chiurazzi C, et al. Mechanical power and development of ventilator-induced lung ınjury. <em>Anesthesiology</em>. 2016; 124(5):1100-1108. doi:10.1097/ALN.0000000000001056
10. Serpa Neto A, Deliberato RO, Johnson AEW, et al. Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts. <em>Intensive Care Med. </em>2018;44(11):1914-1922. doi:10.1007/s00134-018-5375-6
11. Senturk E, Ugur S, Celik Y, Cukurova Z, Asar S, Cakar N. The power of mechanical ventilation may predict mortality in critically ill patients. <em>Minerva Anestesiol</em>. 2023;89(7-8):663-670. doi:10.23736/S0375-9393. 23. 17080-5
12. Yang CK, Teng A, Lee DY, Rose K. Pulmonary complications after major abdominal surgery: national surgical quality ımprovement program analysis. <em>J Surg Res</em>. 2015;198(2):441-449. doi:10.1016/j.jss.2015.03.028
13. Haines KJ, Skinner EH, Berney S, Austin Health POST study ınvestigators. Association of postoperative pulmonary complications with delayed mobilisation following major abdominal surgery: an observational cohort study. <em>Physiotherapy.</em> 2013;99(2):119-125. doi:10.1016/j.physio. 2012.05.013
14. Roukema JA. The prevention of pulmonary complications after upper abdominal surgery in patients with noncompromised pulmonary status. <em>Archives Surg</em>. 1988;123(1):30. doi:10.1001/archsurg.1988. 01400250032004
15. Saracoglu A, Yavru A, Kucukgoncu S, et al. predictive factors ınvolved in development of postoperative pulmonary complications. <em>Turkish J Anesthesia and Reanimation.</em> 2014;42(6):313-319. doi:10.5152/TJAR. 2014.50133
16. Reisli R, Akkaya &Ouml;T, Arıcan Ş, et al. Pharmachologic treatment of acute postoperative pain: a clinical practice guideline of The Turkish society of algology. <em>Agri</em>. 2021;33(50):1-51. doi:10.14744/agri.2021.60243
17. Smetana GW, Lawrence VA, Cornell JE, American college of physicians. preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American college of physicians. <em>Ann Intern Med</em>. 2006;144(8):581-595. doi:10.7326/0003-4819-144-8-200604180-00009
18. Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. <em>Am J Med</em>. 2011;124(2):144-154.e8. doi:10.1016/j.amjmed .2010.09.013
19. Lawrence VA, Dhanda R, Hilsenbeck SG, Page CP. Risk of pulmonary complications after elective abdominal surgery. <em>Chest</em>. 1996;110(3):744-750. doi:10.1378/chest.110.3.744
20. Pasulka PS. The risks of surgery in obese patients. <em>Ann Intern Med. </em>1986;104(4):540. doi:10.7326/0003-4819-104-4-540
21. Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. <em>Anesthesiology. </em>2010;113(6):1338-1350. doi:10.1097/ALN.0b013e3181fc6e0a
22. Kupeli E, Er Dedekarginoglu B, Ulubay G, Oner Eyuboglu F, Haberal M. American society of anesthesiologists classification versus ARISCAT risk ındex: predicting pulmonary complications following renal transplant. <em>Exp Clin Transplant</em>. 2017;15(Suppl 1):208-213. doi:10.6002/ect.mesot 2016.P89
23. Santer P, Zheng S, Hammer M, et al. Ventilatory frequency during intraoperative mechanical ventilation and postoperative pulmonary complications: a hospital registry study. <em>Br J Anaesth. </em>2020;125(1): e130-e139. doi:10.1016/j.bja.2020.02.018
24. Gattinoni L, Collino F, Camporota L. Mechanical power: meaning, uses and limitations. <em>Intensive Care Med</em>. 2023;49(4):465-467. doi:10.1007/s00134-023-06991-3
25. Serpa Neto A, Deliberato RO, Johnson AEW, et al. Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts. <em>Intensive Care Med. </em>2018;44(11):1914-1922. doi:10.1007/s00134-018-5375-6
26. Wu HP, Chu CM, Chuang LP, et al. The association between mechanical power and mortality in patients with pneumonia using pressure-targeted ventilation. <em>Diagnostics</em>. 2021;11(10):1862. doi:10.3390/diagnostics 11101862
27. Parhar KKS, Zjadewicz K, Soo A, et al. Epidemiology, mechanical power, and 3-year outcomes in acute respiratory distress syndrome patients using standardized screening. An observational cohort study. <em>Ann Am Thorac Soc</em>. 2019;16(10):1263-1272. doi:10.1513/AnnalsATS.201812-910OC
28. Santer P, Wachtendorf LJ, Suleiman A, et al. Mechanical power during general anesthesia and postoperative respiratory failure: a multicenter retrospective cohort study. <em>Anesthesiology</em>. 2022;137(1):41-54. doi:10. 1097/ALN.0000000000004256
Article available in :
Volume 1, Issue 4, 2024
Page : 80-85
https://doi.org/10.51271/EAJAIC-0017
Article Information
Received : 08 Eyl 2024
Accepted : 22 Eyl 2024
Published : 15 Eki 2024
Corresponding Author :

Arif Timuroğlu: Department of Anesthesiology and Reanimation, Dr. Abdurrahman Yurtaslan Ankara Oncology Hospital, Ankara, Turkiye

[email protected]
Citation : Engin D, Timuroğlu A, Ünver S. Mechanical power and postoperative pulmonary complications in patients undergoing major abdominal surgery. Eur J Anesthesiol Intensive Care. 2024;1(4):80-85.

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