Intraoperative ventilation risk factors for postoperative pulmonary complications in patients undergoing elective neoplastic esophagectomy: a retrospective cohort study - 30/06/26
, Raphaëlle Lefebvre a, Damien Rousseleau a, c, Emeline Cailliau d, Julien Labreuche b, d, Mouhamed Djahoum Moussa a, b, Alexandre Bourgeois a, b, Julie Veziant e, f, Benoit Tavernier a, b, Gilles Lebuffe a, c, Eric Kipnis a, gGraphical abstract |
Highlights |
• | PPCs remain frequent after elective cancer oesophagectomy. |
• | Plateau pressure, respiratory rate and driving pressure independently predicted PPCs in both TLV and OLV. |
• | In TLV, longer duration increased PPC risk, while higher PEEP was protective. |
• | In OLV, higher tidal volume and mechanical power were associated with higher PPC risk. |
• | Modifiable intraoperative ventilation settings may help reduce pulmonary morbidity after cancer oesophagectomy. |
Abstract |
Background |
Postoperative pulmonary complications (PPCs) are frequent and serious complications after esophagectomy. Our aim was to determine intraoperative ventilatory parameters that are independently associated with PPCs during one-lung ventilation (OLV) and two-lung ventilation (TLV) phases.
Methods |
This retrospective single-center cohort study included 454 patients undergoing elective esophagectomy with combined abdominal and thoracic approaches. The primary outcome was the occurrence of PPCs within seven postoperative days. Separate predictive models were established for OLV and TLV using multivariable logistic regressions with ventilatory parameters.
Results |
PPCs occurred in 194 patients (42.7%). Plateau pressure (Pplat) and driving pressure (DP) were independently associated with PPCs during both phases (Pplat: OR = 1.73, 95%CI: 1.25–2.38, p < 0.001 in OLV; OR = 1.38, 95%CI: 1.00–1.92, p = 0.05 in TLV; DP: OR = 1.17, 95%CI: 1.05–1.30, p = 0.005 in OLV; OR = 1.14, 95%CI: 1.06–1.23, p < 0.001 in TLV). Respiratory rate (RR) was also associated (OR up to 1.62). In TLV, duration of ventilation (OR between 1.39 and 1.41) was associated with PPCs, while positive end-expiratory pressure (PEEP) was protective (OR 0.73). In OLV only, higher tidal volume (VTe) (OR 1.31, 95%CI: 1.303, 1.66, p = 0.02) and mechanical power (MP) (OR = 1.29, 95%CI: 1.00–1.64, p = 0.05) were associated with PPCs. Model discrimination was acceptable (AUC 0.70–0.76).
Conclusions |
Pplat, RR, and DP were associated with PPCs in both ventilation phases. During TLV, duration increased and PEEP decreased PPC risk, whereas during OLV, VTe and MP were associated with PPCs.
Le texte complet de cet article est disponible en PDF.Keywords : Driving pressure, One-lung ventilation, Esophagectomy, Postoperative pulmonary complications, Mechanical power.
Abbreviations : COPD, Crs, DP, ECOG-PS, EPCO, EtCO 2 , FEV1, FiO 2 , HMIE, IQR, MP, PEEP, PPC, Ppeak, Pplat, OLV, RR, SD, SpO 2 , TMIE, TLV, VTe
Plan
Vol 45 - N° 5
Article 101774- septembre 2026 Retour au numéro
Article précédent
- Ultrasound measurement of antral cross-sectional area to predict regurgitation during general anesthesia for cesarean section in laboring women: a prospective observational cohort study
- Longyuan Shen, Qiuxia Jiang, Xiaojuan Yu, Quansheng Xiao, Shengzhao Wang, Xiongda Lin, Qichen Luo, Shaoqiang Huang
- Respiratory events after adenotonsillectomy in children with severe obstructive sleep apnea (OSA): A prospective exploratory study
- Proshad N. Efune, Katie Liu, Paul A. Nakonezny, Kiley F. Poppino, Rita Saynhalath, Ron B. Mitchell, Peter Szmuk
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?