Lung Protective Ventilation Guided by Driving Pressure Improves Pulmonary Outcomes in Heart Transplant Patients

Introduction A prospective observational cohort study was conducted on consecutive patients with end-stage heart failure undergoing orthotopic heart transplantation. The study aimed to compare the effectiveness of two intraoperative ventilation strategies: conventional lung-protective ventilation and driving pressure-guided ventilation.

Methods Patients were divided into two groups at a 1:1 ratio. Group C received conventional lung-protective ventilation, while group D received driving pressure-guided ventilation. The study collected comprehensive clinical data, including baseline characteristics, intraoperative ventilation parameters, surgical information, and outcomes such as the incidence of postoperative pulmonary complications (PPCs), adverse cardiovascular events, and all-cause death.

Ventilation Strategies

• Plan A (Group D): The lowest driving pressure was determined through a 10-cycle experimental ventilation at each level of PEEP after intubation. The PEEP value corresponding to the lowest ΔP was recognized as the optimal ventilation parameter.
• Plan B (Group C): PEEP was maintained at the level facilitating optimal oxygenation during the off-pump period.

Outcomes The primary outcome was the occurrence of new-onset PPCs within 30 days of surgery. Secondary outcomes included perioperative PaO2/FiO2, early/late death, vasoactive-inotropic score at the end of surgery, postoperative adverse cardiovascular events, length of stay in the intensive care unit (LOS-ICU), ventilation assistance time, and postoperative extrapulmonary complications.

Results The study found that driving pressure-guided ventilation significantly reduced the incidence of PPCs compared to conventional lung-protective ventilation. This approach also showed benefits in terms of reduced LOS-ICU and ventilation assistance time, highlighting its potential to improve postoperative recovery and patient outcomes.

Conclusion Lung protective ventilation guided by driving pressure offers a promising strategy to enhance pulmonary outcomes in patients undergoing orthotopic heart transplantation. The findings underscore the importance of individualized ventilation strategies in the perioperative management of high-risk surgical patients.