Positive end-expiratory pressure and the incidence of postoperative pulmonary complications in patients undergoing general anaesthesia

Abstract

General anaesthesia causes atelectasis, which can lead to impaired respiratory function. Positive end-expiratory pressure is a mechanical manoeuvre that increases functional residual capacity and prevents the collapse of the airways, thereby reducing atelectasis. Aim of the study: To evaluate the effect of intraoperative positive end-expiratory pressure and driving pressure on the development of postoperative pulmonary complications. Method: The prospective study included 83 patients undergoing abdominal surgery and receiving general anaesthesia. Patients were divided into two groups: with low intraoperative positive end-expiratory pressure (0–2cm H2O) and with high intraoperative positive end-expiratory pressure (8–10cm H2O). The primary endpoint is the development of postoperative pulmonary complications during follow-up. Results: The incidence of postoperative pulmonary complications in the group of low intraoperative positive end-expiratory pressure was 9.8%, while in the group of high positive end-expiratory pressure was 7.1% (p = 0.6), demonstrating that high positive end-expiratory pressure used during general anaesthesia does not affect the frequency of complications (odds ratio = 0.71, p = 0.6). In the multivariate analysis that controls for all confounders, driving pressure resulted in a significant and independent risk factor for complications. Conclusion: High intraoperative positive end-expiratory pressure does not affect the frequency of postoperative pulmonary complications. The increase in driving pressure is a risk factor for complications. Positive end-expiratory pressure is easily implemented, and its use does not result in significant economic costs.