ArticleAnesthesiology2024
Intraoperative Ventilation/Perfusion Mismatch and Postoperative Pulmonary Complications after Major Noncardiac Surgery: A Prospective Cohort Study.
Article in Anesthesiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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7 citing papers in PubMed.
- Impact of pressure -regulated volume control vs volume -controlled ventilation on respiratory mechanics in pediatric laparoscopic surgery: a randomized controlled trial.Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques · 2026Article
- The relationship between peak pressure and pulmonary complications in complex abdominal wall reconstruction.Hernia : the journal of hernias and abdominal wall surgery · 2026Article
- Inflammatory biomarkers and physiological reserve: an explainable machine learning model for predicting postoperative pulmonary complications in elderly laparoscopic surgery.Frontiers in cellular and infection microbiology · 2026Article
- Development and validation of a nomogram-based model for predicting postoperative pulmonary complications after coronary artery bypass grafting with cardiopulmonary bypass.Indian journal of thoracic and cardiovascular surgery · 2025Article
- Epidemiology and risk of pulmonary complications following hepatobiliary surgical procedures: A retrospective study.World journal of gastrointestinal surgery · 2025Article
- Association between preoperative oxygen reserve index and postoperative pulmonary complications: a prospective observational study.Korean journal of anesthesiology · 2025Observational
- Causes of ventilatory inefficiency in lung resection candidates.ERJ open research · 2025Article
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11 authors.
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Abstract
backgroundPostoperative pulmonary complications can increase hospital length of stay, postoperative morbidity, and mortality. Although many factors can increase the risk of postoperative pulmonary complications, it is not known whether intraoperative ventilation/perfusion (V/Q) mismatch can be associated with an increased risk of postoperative pulmonary complications after major noncardiac surgery.
methodsThis study enrolled patients undergoing general anesthesia for noncardiac surgery and evaluated intraoperative V/Q distribution using the automatic lung parameter estimator technique. The assessment was done after anesthesia induction, after 1 h from surgery start, and at the end of surgery. Demographic and procedural information were collected, and intraoperative ventilatory and hemodynamic parameters were measured at each timepoint. Patients were followed up for 7 days after surgery and assessed daily for postoperative pulmonary complication occurrence.
resultsThe study enrolled 101 patients with a median age of 71 [62 to 77] years, a body mass index of 25 [22.4 to 27.9] kg/m2, and a preoperative Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score of 41 [34 to 47]. Of these patients, 29 (29%) developed postoperative pulmonary complications, mainly acute respiratory failure (23%) and pleural effusion (11%). Patients with and without postoperative pulmonary complications did not differ in levels of shunt at T1 (postoperative pulmonary complications: 22.4% [10.4 to 35.9%] vs. no postoperative pulmonary complications:19.3% [9.4 to 24.1%]; P = 0.18) or during the protocol, whereas significantly different levels of high V/Q ratio were found during surgery (postoperative pulmonary complications: 13 [11 to 15] mmHg vs. no postoperative pulmonary complications: 10 [8 to 13.5] mmHg; P = 0.007) and before extubation (postoperative pulmonary complications: 13 [11 to 14] mmHg vs. no postoperative pulmonary complications: 10 [8 to 12] mmHg; P = 0.006). After adjusting for age, ARISCAT, body mass index, smoking, fluid balance, anesthesia type, laparoscopic procedure and surgery duration, high V/Q ratio before extubation was independently associated with the development of postoperative pulmonary complications (odds ratio, 1.147; 95% CI, 1.021 to 1.289; P = 0.02). The sensitivity analysis showed an E-value of 1.35 (CI, 1.11).
conclusionsIn patients with intermediate or high risk of postoperative pulmonary complications undergoing major noncardiac surgery, intraoperative V/Q mismatch is associated with the development of postoperative pulmonary complications. Increased high V/Q ratio before extubation is independently associated with the occurrence of postoperative pulmonary complications in the first 7 days after surgery. EDITOR’S PERSPECTIVE:
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