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October 03, 2020
10/3/2020 12:00:00 PM - 10/3/2020 1:00:00 PM
Room Virtual
Driving Pressure During One Lung Ventilation And Postoperative Acute Respiratory Distress Syndrome Or Pneumonia
Spencer Walsh, M.D., Hao Zhang, M.D., Alessia Pedoto, M.D., Dawn P. Desiderio, M.D., Kay See Tan, Ph.D., David Amar, M.D.
Memorial Sloan Kettering Cancer Ctr., New York, New York, United States
Disclosures: S. Walsh: None. H. Zhang: None. A. Pedoto: None. D.P. Desiderio: None. K. Tan: None. D. Amar: None.
BACKGROUND: Protective lung ventilation has been defined as a strategy targeting lower plateau pressure (PPLAT), lower tidal volume, and higher positive end expiratory pressure (PEEP) with the goal of improved survival in acute respiratory distress syndrome (ARDS). However, Driving Pressure (DP), defined as PPLAT - PEEP, may be a better variable in predicting survival in ARDS, as it is a better measure of volumetric strain which leads to lung injury.1-2 The goal of this study was to evaluate the relationship between DP and ARDS and/or pneumonia (PNA) in thoracic surgery patients undergoing one lung ventilation (OLV). METHODS: Data were prospectively collected in 599 patients undergoing anatomic pulmonary resection with available DP data after 30 min of stable OLV. The patients who developed ARDS and/or PNA within 30 days post-operation were compared to those that did not develop these complications. Logistic regression models quantified the association between variables and the outcome. RESULTS: Patient characteristics and univariable analysis are shown in Table 1. Multivariable model results (Table 2) showed that DP (OR 1.11, CI 1.01-1.21, p=0.024) and use of colloid (OR 2.72, CI 1.12-6.59, p=0.027)) were significantly associated with ARDS/PNA occurrence. CONCLUSIONS: In patients undergoing anatomic pulmonary resection with OLV, DP was the only ventilation parameter jointly with colloid administration to achieve a significant association with ARDS/PNA occurrence. Further study is warranted to see if a ventilation strategy targeting lower DP during OLV could lead to improved pulmonary outcomes for thoracic surgery patients.

References: 1. Amato MB, Meade MO, Slutsky AS, Brochard L, Costa EL, Schoenfeld DA, Stewart TE, Briel M, Talmor D, Mercat A, Richard JC, Carvalho CR, Brower RG: Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015; 372(8):747-55. 2. Williams EC, Motta-Ribeiro GC, Melo MFV: Driving Pressure and Transpulmonary Pressure. Anesthesiology 2019; 131:155-63.
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