# Impact of intraoperative ventilation parameters on postoperative outcomes in thoracic surgery: a multicenter registry-based analysis

## TL;DR

This study shows that certain ventilation settings during thoracic surgery can increase the risk of complications and mortality.

## Contribution

The study identifies specific ventilation parameters linked to worse postoperative outcomes in thoracic surgery patients.

## Key findings

- Elevated driving pressure, pMax, and PEEP during surgery are associated with higher complication and mortality rates.
- Tidal volume greater than 5 mL/kg PBW increases complication rates.
- OLV duration over 60 minutes and pMax >25 mbar are independent predictors of respiratory complications.

## Abstract

One-lung ventilation (OLV) is a standard technique during thoracic surgery, yet its impact on postoperative complications and ventilator settings remains under investigation. The objective of this study was to evaluate the impact of intraoperative ventilation parameters on postoperative outcomes in patients undergoing thoracic surgery with OLV.

A retrospective multicenter cohort analysis was conducted using data from the German Thoracic Registry.

The study encompassed 2,922 patients treated between 2017 and 2021 across eight German centers.

Intraoperative variables analyzed included driving pressure (DP), positive end-expiratory pressure (PEEP), maximum airway pressure (pMax), tidal volume (TV) per predicted body weight (PBW), and ventilation mode. The primary outcomes of interest were postoperative complications, respiratory complications, and in-hospital mortality.

Postoperative complications occurred in 28.7% of cases. Elevated DP (>20 mbar), pMax (>25 mbar), and PEEP (>8 mbar) were significantly associated with increased complication and mortality rates. Patients receiving a TV > 5 mL/kg PBW also showed higher complication rates (p = .003). Respiratory complications occurred in 15.7% of patients and were strongly associated with higher DP, pMax, and OLV duration. Multivariate logistic regression identified OLV > 60 min and pMax >25 mbar as independent predictors of respiratory complications and overall complications.

Intraoperative ventilation parameters, particularly elevated DP, pMax and PEEP, have been demonstrated to be associated with an increased risk of complications and mortality in patients undergoing thoracic surgery with OLV. These findings lend support to the hypothesis that lung-protective ventilation strategies may improve perioperative outcomes.