Thomas Bluth, Eva Rivas, Manuel López-Baamonde, Josep Martí Sanahuja, Antonio López-Hernández, Jaume Balust, Toby N Weingarten, Felix Girrbach, Philipp Simon, Hermann Wrigge, Jakob Wittenstein, Katharina Birr, Robert Teichmann, Robert Huhle, Niklas Melchior, Luigi Vivona, Thea Koch, Harish Ramakrishna, Sorin Brull, Ary Serpa Neto, Marcus J Schultz, Juraj Sprung, Martin Scharffenberg, Marcelo Gama de Abreu
{"title":"肥胖手术患者肺损伤血浆生物标志物与呼气末正压和术后肺部并发症的关联：PROBESE随机对照试验的一项亚研究","authors":"Thomas Bluth, Eva Rivas, Manuel López-Baamonde, Josep Martí Sanahuja, Antonio López-Hernández, Jaume Balust, Toby N Weingarten, Felix Girrbach, Philipp Simon, Hermann Wrigge, Jakob Wittenstein, Katharina Birr, Robert Teichmann, Robert Huhle, Niklas Melchior, Luigi Vivona, Thea Koch, Harish Ramakrishna, Sorin Brull, Ary Serpa Neto, Marcus J Schultz, Juraj Sprung, Martin Scharffenberg, Marcelo Gama de Abreu","doi":"10.1097/EJA.0000000000002221","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The effect of positive end expiratory pressure (PEEP) on postoperative pulmonary complications (PPCs) in obese patients remains controversial.</p><p><strong>Objective: </strong>To test, whether intra-operative PEEP or PPCs are associated with plasma levels of biomarkers of lung injury.</p><p><strong>Design: </strong>A prospective substudy of a multicentre randomised controlled trial (PROBESE).</p><p><strong>Setting: </strong>Operating rooms of six tertiary care centres in the United States and Europe.</p><p><strong>Patients: </strong>Obese patients at risk for PPCs undergoing abdominal surgery.</p><p><strong>Intervention: </strong>Intra-operative low tidal volume ventilation with high PEEP (12 cmH 2 O) and recruitment manoeuvres, or low PEEP (4 cmH 2 O).</p><p><strong>Main outcome measures: </strong>The primary endpoint was the association between absolute postoperative plasma levels of receptor for advanced glycation end-products (RAGE) and intra-operative PEEP; secondary endpoints included pre and postoperative plasma concentrations as well as the relative changes of interleukin-6, IL-8, tumour necrosis factor-α, surfactant protein D, mucin-1, clara cell protein-16, intercellular adhesion molecule-1 and vascular cell adhesion molecule. PPCs were assessed as a 'collapsed composite' of adverse pulmonary events. The predictive ability of biomarkers for PPCs was assessed with the receiver operating curve-area under the curve (ROC-AUC).</p><p><strong>Results: </strong>A total of 96 patients received low PEEP, and 95 patients high PEEP. Postoperative plasma concentrations of RAGE and other biomarkers did not differ between groups. The relative increase of RAGE during surgery was more pronounced with low than high PEEP; median [IQR], 1.2 [1.0 to 1.6] vs. 1.1 [0.9 to 1.3], P = 0.012. Patients who developed PPCs showed higher postoperative plasma levels and relative increase of IL-6; 26.3 [12.6 to 139.5] vs. 15.1 [3.7 to 38.7] fold change. The ROC-AUC was less than 0.7 for all biomarkers.</p><p><strong>Conclusions: </strong>In this subgroup, choice of PEEP did not affect postoperative biomarkers of lung injury. Irrespective of PEEP, PPCs were associated with an increase in plasma levels of these biomarkers, but their predictive capability was poor.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov, identifier: NCT02148692.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"840-850"},"PeriodicalIF":6.8000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association of plasma biomarkers of lung injury with positive end expiratory pressure and postoperative pulmonary complications in obese surgical patients: A substudy of the PROBESE randomised controlled trial.\",\"authors\":\"Thomas Bluth, Eva Rivas, Manuel López-Baamonde, Josep Martí Sanahuja, Antonio López-Hernández, Jaume Balust, Toby N Weingarten, Felix Girrbach, Philipp Simon, Hermann Wrigge, Jakob Wittenstein, Katharina Birr, Robert Teichmann, Robert Huhle, Niklas Melchior, Luigi Vivona, Thea Koch, Harish Ramakrishna, Sorin Brull, Ary Serpa Neto, Marcus J Schultz, Juraj Sprung, Martin Scharffenberg, Marcelo Gama de Abreu\",\"doi\":\"10.1097/EJA.0000000000002221\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The effect of positive end expiratory pressure (PEEP) on postoperative pulmonary complications (PPCs) in obese patients remains controversial.</p><p><strong>Objective: </strong>To test, whether intra-operative PEEP or PPCs are associated with plasma levels of biomarkers of lung injury.</p><p><strong>Design: </strong>A prospective substudy of a multicentre randomised controlled trial (PROBESE).</p><p><strong>Setting: </strong>Operating rooms of six tertiary care centres in the United States and Europe.</p><p><strong>Patients: </strong>Obese patients at risk for PPCs undergoing abdominal surgery.</p><p><strong>Intervention: </strong>Intra-operative low tidal volume ventilation with high PEEP (12 cmH 2 O) and recruitment manoeuvres, or low PEEP (4 cmH 2 O).</p><p><strong>Main outcome measures: </strong>The primary endpoint was the association between absolute postoperative plasma levels of receptor for advanced glycation end-products (RAGE) and intra-operative PEEP; secondary endpoints included pre and postoperative plasma concentrations as well as the relative changes of interleukin-6, IL-8, tumour necrosis factor-α, surfactant protein D, mucin-1, clara cell protein-16, intercellular adhesion molecule-1 and vascular cell adhesion molecule. PPCs were assessed as a 'collapsed composite' of adverse pulmonary events. The predictive ability of biomarkers for PPCs was assessed with the receiver operating curve-area under the curve (ROC-AUC).</p><p><strong>Results: </strong>A total of 96 patients received low PEEP, and 95 patients high PEEP. Postoperative plasma concentrations of RAGE and other biomarkers did not differ between groups. The relative increase of RAGE during surgery was more pronounced with low than high PEEP; median [IQR], 1.2 [1.0 to 1.6] vs. 1.1 [0.9 to 1.3], P = 0.012. Patients who developed PPCs showed higher postoperative plasma levels and relative increase of IL-6; 26.3 [12.6 to 139.5] vs. 15.1 [3.7 to 38.7] fold change. The ROC-AUC was less than 0.7 for all biomarkers.</p><p><strong>Conclusions: </strong>In this subgroup, choice of PEEP did not affect postoperative biomarkers of lung injury. Irrespective of PEEP, PPCs were associated with an increase in plasma levels of these biomarkers, but their predictive capability was poor.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov, identifier: NCT02148692.</p>\",\"PeriodicalId\":11920,\"journal\":{\"name\":\"European Journal of Anaesthesiology\",\"volume\":\" \",\"pages\":\"840-850\"},\"PeriodicalIF\":6.8000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Anaesthesiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/EJA.0000000000002221\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/6/20 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Anaesthesiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/EJA.0000000000002221","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/20 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Association of plasma biomarkers of lung injury with positive end expiratory pressure and postoperative pulmonary complications in obese surgical patients: A substudy of the PROBESE randomised controlled trial.
Background: The effect of positive end expiratory pressure (PEEP) on postoperative pulmonary complications (PPCs) in obese patients remains controversial.
Objective: To test, whether intra-operative PEEP or PPCs are associated with plasma levels of biomarkers of lung injury.
Design: A prospective substudy of a multicentre randomised controlled trial (PROBESE).
Setting: Operating rooms of six tertiary care centres in the United States and Europe.
Patients: Obese patients at risk for PPCs undergoing abdominal surgery.
Intervention: Intra-operative low tidal volume ventilation with high PEEP (12 cmH 2 O) and recruitment manoeuvres, or low PEEP (4 cmH 2 O).
Main outcome measures: The primary endpoint was the association between absolute postoperative plasma levels of receptor for advanced glycation end-products (RAGE) and intra-operative PEEP; secondary endpoints included pre and postoperative plasma concentrations as well as the relative changes of interleukin-6, IL-8, tumour necrosis factor-α, surfactant protein D, mucin-1, clara cell protein-16, intercellular adhesion molecule-1 and vascular cell adhesion molecule. PPCs were assessed as a 'collapsed composite' of adverse pulmonary events. The predictive ability of biomarkers for PPCs was assessed with the receiver operating curve-area under the curve (ROC-AUC).
Results: A total of 96 patients received low PEEP, and 95 patients high PEEP. Postoperative plasma concentrations of RAGE and other biomarkers did not differ between groups. The relative increase of RAGE during surgery was more pronounced with low than high PEEP; median [IQR], 1.2 [1.0 to 1.6] vs. 1.1 [0.9 to 1.3], P = 0.012. Patients who developed PPCs showed higher postoperative plasma levels and relative increase of IL-6; 26.3 [12.6 to 139.5] vs. 15.1 [3.7 to 38.7] fold change. The ROC-AUC was less than 0.7 for all biomarkers.
Conclusions: In this subgroup, choice of PEEP did not affect postoperative biomarkers of lung injury. Irrespective of PEEP, PPCs were associated with an increase in plasma levels of these biomarkers, but their predictive capability was poor.
期刊介绍：
The European Journal of Anaesthesiology (EJA) publishes original work of high scientific quality in the field of anaesthesiology, pain, emergency medicine and intensive care. Preference is given to experimental work or clinical observation in man, and to laboratory work of clinical relevance. The journal also publishes commissioned reviews by an authority, editorials, invited commentaries, special articles, pro and con debates, and short reports (correspondences, case reports, short reports of clinical studies).
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