Effects of driving pressure-guided ventilation on postoperative pulmonary complications in patients with COVID-19 undergoing abdominal surgery: A post-hoc propensity score-matched analysis.

Background: Application of individualized positive end-expiratory pressure (PEEP) based on minimum driving pressure facilitates to prevent from postoperative pulmonary complications (PPCs). Whether lung protective ventilation strategy can reduce the risk of PPCs in COVID-19 patients remains unclear. In this study, we compared the effects of driving pressure-guided ventilation with conventional mechanical ventilation on PPCs in patients with COVID-19.

Methods: Patients infected COVID-19 within 30-day before surgery were retrospectively enrolled consecutively. Patients were divided into two group: driving pressure-guided lung protective ventilation strategy group (LPVS group) and conventional mechanical ventilation group (Control group). Propensity score matching for variables selected was used by logistic regression with the nearest-neighbor method. The outcomes were the incidence of PPCs and hypoxemia in post-anesthesia care unit.

Results: There was no significant difference in the baseline data between both groups ( > 0.05). The incidence of PPCs (12.73 % vs 36.36 %,  = 7.068,  = 0.008) and hypoxemia [18.18 % vs 38.18 %,  = 4.492,  = 0.034], and lung ultrasound scores [4.68 ± 1.60 vs 8.39 ± 1.87,  = 8.383,  < 0.001] in LPVS group were lower than control group. The PEEP, airway pressure and plateau pressure in LPVS group were higher than control group, but driving pressure and tidal volume was lower than control group, the difference was statistically significant ( < 0.05).

Conclusion: Individualized PEEP ventilation strategy guided by minimum driving pressure could improve oxygenation and reduce the incidence of PPCs in surgical patients with COVID-19.