Drive Pressure-Guided Individualized Positive End-Expiratory Pressure in Traumatic Brain Injury Surgery: A Randomized Controlled Trial.

IF 0.9 4区 医学 Q3 SURGERY
Xiaoping Chen, Zi Wang, Yali Ge, Ju Gao, Liuqing Yang
{"title":"Drive Pressure-Guided Individualized Positive End-Expiratory Pressure in Traumatic Brain Injury Surgery: A Randomized Controlled Trial.","authors":"Xiaoping Chen, Zi Wang, Yali Ge, Ju Gao, Liuqing Yang","doi":"10.62713/aic.3513","DOIUrl":null,"url":null,"abstract":"<p><strong>Aim: </strong>Intraoperative lung-protective ventilation strategies (LPVS) have been shown to improve lung oxygenation and prevent postoperative pulmonary problems in surgical patients. However, the application of positive end-expiratory pressure (PEEP)-based LPVS in emergency traumatic brain injury (TBI) has not been thoroughly explored. The purpose of this study is to evaluate the effects of drive pressure-guided individualized PEEP on perioperative pulmonary oxygenation, postoperative pulmonary complications, and recovery from neurological injury in patients with TBI.</p><p><strong>Methods: </strong>A total of 111 TBI patients who met the inclusion criteria at Northern Jiangsu People's Hospital were randomized into three groups: group A (0 PEEP, 50% inhaled oxygen concentration, and 6 mL/kg tidal volume), group B (5 cmH2O PEEP, 50% inhaled oxygen concentration, and 6 mL/kg tidal volume), and group C (individualized PEEP guided by driving pressure, 50% inhaled oxygen concentration, and 6 mL/kg tidal volume). The primary endpoints were lung ultrasound score (LUS), optic nerve sheath diameter (ONSD), and serum levels of neuron-specific enolase (NSE) and High mobility group box 1 protein (HMGB1). Secondary endpoints included intraoperative hemodynamic and respiratory mechanics parameters, postoperative pulmonary complications, and clinical lung infection scores.</p><p><strong>Results: </strong>Eighty-nine patients completed the final analysis. LUS was significantly lower in group C compared to group A at T4 (least square mean [95% confidence interval (CI)]: 2.50 [1.35, 3.65] vs. 5.25 [4.10, 6.40], p < 0.05). Although ONSD increased gradually in group C, it did not differ substantially from group A postoperatively (least square mean [95% CI]: 5.09 [4.90, 5.27] vs 5.16 [4.97, 5.34] mm, p > 0.05). Serum NSE levels in group C were significantly lower on postoperative days 1 (4.40 [3.89, 4.41] vs. 10.95 [10.44, 11.46], p < 0.05) and 3 (2.79 [2.28, 3.30] vs. 10.95 [10.44, 11.46], p < 0.05). Additionally, serum HMGB1 levels in group C were significantly reduced on postoperative days 1 (229 [200, 258] vs. 662 [633, 691], p < 0.05) and 3 (166 [137, 195] vs. 662 [633, 691], p < 0.05).</p><p><strong>Conclusions: </strong>Individualized PEEP guided by driving pressure can improve perioperative pulmonary oxygenation and reduce the incidence of postoperative pulmonary complications. Furthermore, this strategy did not significantly elevate intraoperative intracranial pressure (ICP) and promoted recovery from postoperative neurological injury, likely by reducing the inflammatory response.</p><p><strong>Clinical trial registration: </strong>https://www.chictr.org.cn/ (clinical trial no. ChiCTR2200066795).</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"95 6","pages":"1249-1260"},"PeriodicalIF":0.9000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annali italiani di chirurgia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.62713/aic.3513","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0

Abstract

Aim: Intraoperative lung-protective ventilation strategies (LPVS) have been shown to improve lung oxygenation and prevent postoperative pulmonary problems in surgical patients. However, the application of positive end-expiratory pressure (PEEP)-based LPVS in emergency traumatic brain injury (TBI) has not been thoroughly explored. The purpose of this study is to evaluate the effects of drive pressure-guided individualized PEEP on perioperative pulmonary oxygenation, postoperative pulmonary complications, and recovery from neurological injury in patients with TBI.

Methods: A total of 111 TBI patients who met the inclusion criteria at Northern Jiangsu People's Hospital were randomized into three groups: group A (0 PEEP, 50% inhaled oxygen concentration, and 6 mL/kg tidal volume), group B (5 cmH2O PEEP, 50% inhaled oxygen concentration, and 6 mL/kg tidal volume), and group C (individualized PEEP guided by driving pressure, 50% inhaled oxygen concentration, and 6 mL/kg tidal volume). The primary endpoints were lung ultrasound score (LUS), optic nerve sheath diameter (ONSD), and serum levels of neuron-specific enolase (NSE) and High mobility group box 1 protein (HMGB1). Secondary endpoints included intraoperative hemodynamic and respiratory mechanics parameters, postoperative pulmonary complications, and clinical lung infection scores.

Results: Eighty-nine patients completed the final analysis. LUS was significantly lower in group C compared to group A at T4 (least square mean [95% confidence interval (CI)]: 2.50 [1.35, 3.65] vs. 5.25 [4.10, 6.40], p < 0.05). Although ONSD increased gradually in group C, it did not differ substantially from group A postoperatively (least square mean [95% CI]: 5.09 [4.90, 5.27] vs 5.16 [4.97, 5.34] mm, p > 0.05). Serum NSE levels in group C were significantly lower on postoperative days 1 (4.40 [3.89, 4.41] vs. 10.95 [10.44, 11.46], p < 0.05) and 3 (2.79 [2.28, 3.30] vs. 10.95 [10.44, 11.46], p < 0.05). Additionally, serum HMGB1 levels in group C were significantly reduced on postoperative days 1 (229 [200, 258] vs. 662 [633, 691], p < 0.05) and 3 (166 [137, 195] vs. 662 [633, 691], p < 0.05).

Conclusions: Individualized PEEP guided by driving pressure can improve perioperative pulmonary oxygenation and reduce the incidence of postoperative pulmonary complications. Furthermore, this strategy did not significantly elevate intraoperative intracranial pressure (ICP) and promoted recovery from postoperative neurological injury, likely by reducing the inflammatory response.

Clinical trial registration: https://www.chictr.org.cn/ (clinical trial no. ChiCTR2200066795).

颅脑外伤手术中驱动压力引导个体化呼气末正压:一项随机对照试验。
目的:术中肺保护性通气策略(LPVS)已被证明可以改善手术患者的肺氧合并预防术后肺部问题。然而,基于呼气末正压(PEEP)的LPVS在急诊创伤性脑损伤(TBI)中的应用尚未得到深入的探讨。本研究的目的是评估驱动压力引导个体化PEEP对TBI患者围术期肺氧合、术后肺部并发症和神经损伤恢复的影响。方法:将苏北人民医院符合纳入标准的111例TBI患者随机分为3组:A组(0 PEEP、50%吸氧浓度、6 mL/kg潮气量)、B组(5 cmH2O PEEP、50%吸氧浓度、6 mL/kg潮气量)和C组(驱动压力、50%吸氧浓度、6 mL/kg潮气量引导下个体化PEEP)。主要终点为肺超声评分(LUS)、视神经鞘直径(ONSD)、血清神经元特异性烯醇化酶(NSE)和高迁移率组框1蛋白(HMGB1)水平。次要终点包括术中血流动力学和呼吸力学参数、术后肺部并发症和临床肺部感染评分。结果:89例患者完成最终分析。C组T4时LUS明显低于A组(最小二乘平均值[95%可信区间(CI)]: 2.50[1.35, 3.65]对5.25 [4.10,6.40],p < 0.05)。术后C组ONSD虽逐渐升高,但与A组无显著差异(最小二乘均值[95% CI]: 5.09 [4.90, 5.27] vs 5.16 [4.97, 5.34] mm, p < 0.05)。C组患者术后第1天血清NSE水平(4.40[3.89,4.41]比10.95 [10.44,11.46],p < 0.05)和第3天血清NSE水平(2.79[2.28,3.30]比10.95 [10.44,11.46],p < 0.05)均显著降低。此外,C组患者术后第1天血清HMGB1水平显著降低(229[200,258]比662 [633,691],p < 0.05),第3天血清HMGB1水平显著降低(166[137,195]比662 [633,691],p < 0.05)。结论:驱动压引导个体化PEEP可改善围术期肺氧合,减少术后肺部并发症的发生。此外,这种策略并没有显著提高术中颅内压(ICP),也没有促进术后神经损伤的恢复,这可能是通过减少炎症反应来实现的。临床试验注册:https://www.chictr.org.cn/(临床试验编号:ChiCTR2200066795)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
0.90
自引率
12.50%
发文量
116
审稿时长
>12 weeks
期刊介绍: Annali Italiani di Chirurgia is a bimonthly journal and covers all aspects of surgery:elective, emergency and experimental surgery, as well as problems involving technology, teaching, organization and forensic medicine. The articles are published in Italian or English, though English is preferred because it facilitates the international diffusion of the journal (v.Guidelines for Authors and Norme per gli Autori). The articles published are divided into three main sections:editorials, original articles, and case reports and innovations.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信