LDPEEPPC
Trial question
What is the effect of PEEP titration to the lowest driving pressure in patients undergoing selective lung resection surgery?
Study design
Single center
Double blinded
RCT
Population
Characteristics of study participants
47.0% female
53.0% male
N = 207
207 patients (98 female, 109 male).
Inclusion criteria: patients undergoing selective lung resection surgery.
Key exclusion criteria: age < 18 years; pregnancy.
Interventions
N=104 PEEP titration to the lowest driving pressure (PEEP titration to the lowest driving pressure during one-lung ventilation).
N=103 conventional low level of PEEP (PEEP level of 4 cmH₂O during one-lung ventilation).
Primary outcome
Rate of development of ≥ 4 Melbourne Group Scale variables within 3 postoperative days
4%
13%
13.0 %
9.8 %
6.5 %
3.3 %
0.0 %
Positive end-expiratory pressure titration to the lowest driving
pressure
Conventional low level of positive end-expiratory
pressure
Significant
decrease ▼
NNT = 11
Significant decrease in the rate of development of ≥ 4 Melbourne Group Scale variables within 3 postoperative days (4% vs. 13%; RR 0.32, 95% CI 0.1 to 0.9).
Secondary outcomes
No significant difference in the rate of major postoperative pulmonary complications within 7 postoperative days (96% vs. 96%; RR 1, 95% CI 0.95 to 1.06).
No significant difference in CXR atelectasis or infiltration (79% vs. 75%; RR 1.06, 95% CI 0.91 to 1.23).
Conclusion
In patients undergoing selective lung resection surgery, PEEP titration to the lowest driving pressure was superior to conventional low level of PEEP with respect to the rate of development of ≥ 4 Melbourne Group Scale variables within 3 postoperative days.
Reference
Junjie Yu, Zhijie Wu, Rui An et al. Association between driving pressure and postoperative pulmonary complications in patients undergoing lung resection surgery: A randomised clinical trial. Anaesth Crit Care Pain Med. 2022 Sep 19;42(1):101160.
Open reference URL