PMID- 32223967 OWN - NLM STAT- MEDLINE DCOM- 20200713 LR - 20210702 IS - 1471-6771 (Electronic) IS - 0007-0912 (Print) IS - 0007-0912 (Linking) VI - 125 IP - 1 DP - 2020 Jul TI - Ventilatory frequency during intraoperative mechanical ventilation and postoperative pulmonary complications: a hospital registry study. PG - e130-e139 LID - S0007-0912(20)30133-1 [pii] LID - 10.1016/j.bja.2020.02.018 [doi] AB - BACKGROUND: High ventilatory frequencies increase static lung strain and possibly lung stress by shortening expiratory time, increasing intrathoracic pressure, and causing dynamic hyperinflation. We hypothesised that high intraoperative ventilatory frequencies were associated with postoperative respiratory complications. METHODS: In this retrospective hospital registry study, we analysed data from adult non-cardiothoracic surgical cases performed under general anaesthesia with mechanical ventilation at a single centre between 2005 and 2017. We assessed the association between intraoperative ventilatory frequency (categorised into four groups) and postoperative respiratory complications, defined as composite of invasive mechanical ventilation within 7 days after surgery or peripheral oxygen desaturation after extubation, using multivariable logistic regression. In a subgroup, we adjusted analyses for arterial blood gas parameters. RESULTS: A total of 102 632 cases were analysed. Intraoperative ventilatory frequencies ranged from a median (inter-quartile range [IQR]) of 8 (8-9) breaths min(-1) (Group 1) to 15 (14-18) breaths min(-1) (Group 4). High ventilatory frequencies were associated with higher odds of postoperative respiratory complications (adjusted odds ratio=1.26; 95% confidence interval, 1.14-1.38; P<0.001), which was confirmed in a subgroup after adjusting for arterial partial pressure of carbon dioxide and the ratio of arterial oxygen partial pressure to fractional inspired oxygen. We identified considerable variability in the use of high ventilatory frequencies attributable to individual provider preference (ranging from 22% to 88%) and temporal change; however, the association with postoperative respiratory complications remained unaffected. CONCLUSIONS: High intraoperative ventilatory frequency was associated with increased risk of postoperative respiratory complications, and increased postoperative healthcare utilisation. CI - Copyright (c) 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved. FAU - Santer, Peter AU - Santer P AD - Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. FAU - Zheng, Shengxing AU - Zheng S AD - Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Anesthesia and Critical Care, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China. FAU - Hammer, Maximilian AU - Hammer M AD - Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. FAU - Nabel, Sarah AU - Nabel S AD - Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. FAU - Pannu, Ameeka AU - Pannu A AD - Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. FAU - Li, Yunping AU - Li Y AD - Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. FAU - Ramachandran, Satya Krishna AU - Ramachandran SK AD - Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. FAU - Vidal Melo, Marcos F AU - Vidal Melo MF AD - Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. FAU - Eikermann, Matthias AU - Eikermann M AD - Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Klinik fur Anasthesiologie und Intensivmedizin, Universitat Duisburg-Essen, Essen, Germany. Electronic address: meikerma@bidmc.harvard.edu. LA - eng GR - UG3 HL140177/HL/NHLBI NIH HHS/United States GR - UH3 HL140177/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20200326 PL - England TA - Br J Anaesth JT - British journal of anaesthesia JID - 0372541 SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Female MH - Hospitals MH - Humans MH - Intraoperative Care/*adverse effects/*methods MH - Male MH - Massachusetts/epidemiology MH - Middle Aged MH - Postoperative Complications/etiology/*physiopathology MH - Registries MH - Respiration Disorders/etiology/*physiopathology MH - Respiration, Artificial/*adverse effects/*methods MH - Retrospective Studies MH - Tidal Volume MH - Time MH - Young Adult PMC - PMC7844371 OTO - NOTNLM OT - desaturation OT - intraoperative mechanical ventilation OT - perioperative care OT - postoperative respiratory complications OT - reintubation OT - ventilatory frequency EDAT- 2020/04/01 06:00 MHDA- 2020/07/14 06:00 PMCR- 2021/07/01 CRDT- 2020/04/01 06:00 PHST- 2019/12/05 00:00 [received] PHST- 2020/02/03 00:00 [revised] PHST- 2020/02/24 00:00 [accepted] PHST- 2020/04/01 06:00 [pubmed] PHST- 2020/07/14 06:00 [medline] PHST- 2020/04/01 06:00 [entrez] PHST- 2021/07/01 00:00 [pmc-release] AID - S0007-0912(20)30133-1 [pii] AID - 10.1016/j.bja.2020.02.018 [doi] PST - ppublish SO - Br J Anaesth. 2020 Jul;125(1):e130-e139. doi: 10.1016/j.bja.2020.02.018. Epub 2020 Mar 26.