Driving Pressure during Lung Resection
Research type
Research Study
Full title
The relationship between driving pressure and the incidence of major respiratory complications following surgical resection of lung cancer
IRAS ID
219015
Contact name
Ben Shelley
Contact email
Sponsor organisation
NWTC Board
Duration of Study in the UK
0 years, 5 months, 30 days
Research summary
Lung cancer is the leading cause of cancer death in the UK. In suitable cases, the best chance of cure comes from surgical resection. Due to high levels of heart and lung disease in this patient group however, this surgery is associated with significant risk of cardio-respiratory complications.
Acute respiratory distress syndrome (ARDS - a severe form of lung injury) is the leading cause of early post-operative mortality in this group of patients and has a mortality exceeding 50%. It has been increasingly understood that the way in which the lung is mechanically ventilated during the operation is a significant risk factor for the subsequent development of lung injury.
In the general intensive care population, there is good evidence that so called ‘lung protective ventilation’ (LPV) minimising lung damage from excessive airway pressures (‘barotrauma’) and excessive tidal volumes (‘volutrauma’) minimises the risk of lung injury and leads to improved outcomes in patients with ARDS. Principles of lung protective ventilation have since been translated to the operating theatre environment with evidence to suggest that LPV improves perioperative outcomes.
Recently, the understanding of the damaging effects of airway pressures has been progressed by Amato’s et al’s observation that it is ‘driving pressure’ (the cyclical change in airway pressure during each breath) rather than the peak airway pressure (as previously believed) that is important in the pathogenesis of lung injury. As such, LPV strategies seeking to minimise driving pressure are being tested.
This study will examine whether the relationship between lung injury and driving pressure previously observed is applicable to patients undergoing thoracic surgery. In this single centre retrospective observational study, we seek to look back through the patient records of patients undergoing lung resection and examine any association between ventilator driving pressure during the operation and post-operative outcomes.
REC name
West Midlands - Edgbaston Research Ethics Committee
REC reference
17/WM/0388
Date of REC Opinion
27 Oct 2017
REC opinion
Favourable Opinion