Perioperative medicine & outcomes
The effect of intraoperative positive end expiratory pressure and tidal volume on postoperative acute kidney injury after orthopedic surgery
Authors' conclusion
Higher levels of PEEP or TV during mechanical ventilation in adult patients undergoing orthopedic surgeries under general anesthesia do not increase the odds of developing postoperative AKI within the narrow limits studied.
Study context
- Population
- Adults undergoing orthopedic surgery under GA, Cleveland Clinic, Cleveland, OHincluded in the analysis
- Participants
- 1,933 adults
- Comparison
- PEEP 5 vs 8 cm H2O and TV 6 vs 10 mL/kg PBW
- Primary endpoint
- Postoperative AKI (KDIGO criteria; baseline = closest preoperative creatinine within 30 days, postoperative = highest creatinine within 7 days)
- Follow-up
- Within 7 days after surgery
Methodological detailsnon-randomized, cross over, factorial (4 PEEP/TV combinations alternating weekly), single-centre
- Non-randomized
- Cross over
- Factorial (4 PEEP/TV combinations alternating weekly)
- Single-centre
Primary result
As reported in the abstract
Odds ratio (97.5% CI)P value
TV = 6 mL/kg vs TV = 10 mL/kg
0.96(0.63–1.46)
P = 0.811PEEP = 5cm H2 O vs PEEP = 8cm H2 O
0.92(0.60–1.39)
P = 0.623- AKI incidence in the study population
- 6.8%
Secondary outcomes
Maximum postoperative in-hospital creatinine within 7 days
- Neither TV nor PEEP had a significant effect on creatinine levels
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
The effect of intraoperative positive end expiratory pressure and tidal volume on postoperative acute kidney injury after orthopedic surgery. Acta Anaesthesiol Scand. Published 31 August 2023. doi:10.
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