Risk of postoperative pneumonia after extubation with the positive pressure versus normal pressure technique: a single-center retrospective observational study

IF 2.8 3区医学 Q2 ANESTHESIOLOGY Journal of Anesthesia Pub Date : 2024-09-12 DOI:10.1007/s00540-024-03409-2

Kensuke Shimada, Masahiko Gosho, Tomohiro Ohigashi, Keitaro Kume, Takahiro Yano, Ryota Ishii, Kazushi Maruo, Ryota Inokuchi, Masao Iwagami, Hiroshi Ueda, Makoto Tanaka, Masaru Sanuki, Nanako Tamiya

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Abstract

Purpose

A normal pressure extubation technique (no lung inflation before extubation), proposed by the Japanese Society of Anesthesiologists to prevent droplet infection during the coronavirus disease 2019 (COVID-19) pandemic, could theoretically increase postoperative pneumonia incidence compared with a positive pressure extubation technique (lung inflation before extubation). However, the normal pressure extubation technique has not been adequately evaluated. This study compared postoperative pneumonia incidence between positive and normal pressure extubation techniques using a dataset from the University of Tsukuba Hospital.

Methods

In our hospital, the extubation methods changed from positive to normal pressure extubation techniques on March 3, 2020 due to the COVID-19 pandemic. Thus, we compared the risk of postoperative pneumonia between the positive (April 1, 2017 to December 31, 2019) and normal pressure extubation techniques (March 3, 2020 to March 31, 2022) using propensity score analyses. Postoperative pneumonia was defined using the International Classification of Diseases, 10th Edition (ICD-10) codes (J13–J18), and we reviewed the medical records of patients flagged with these ICD-10 codes (preoperative pneumonia and ICD-10 codes for prophylactic antibiotic prescriptions for pneumonia).

Results

We identified 20,011 surgeries, including 11,920 in the positive pressure extubation group (mean age 48.2 years, standard deviation [SD] 25.2 years) and 8,091 in the normal pressure extubation group (mean age 47.8 years, SD 25.8 years). The postoperative pneumonia incidences were 0.19% (23/11,920) and 0.17% (14/8,091) in the positive and normal pressure extubation groups, respectively. The propensity score analysis using inverse probability weighting revealed no significant difference in postoperative pneumonia incidence between the two groups (adjusted odds ratio 0.98, 95% confidence interval 0.50 to 1.91, P = 0.94).

Conclusions

These results indicated no increased risk of postoperative pneumonia associated with the normal pressure extubation technique compared with the positive pressure extubation technique.

Clinical trial number

Clinical trial number: UMIN000048589 https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000055364

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采用正压与常压技术拔管后术后肺炎的风险：一项单中心回顾性观察研究

目的日本麻醉医师协会为预防 2019 年冠状病毒病（COVID-19）大流行期间的飞沫感染而提出的常压拔管技术（拔管前不进行肺充气）与正压拔管技术（拔管前进行肺充气）相比，理论上可能会增加术后肺炎的发生率。然而，正压拔管技术尚未得到充分评估。本研究使用筑波大学附属医院的数据集，比较了正压和常压拔管技术的术后肺炎发生率。方法由于 COVID-19 大流行，我院于 2020 年 3 月 3 日将拔管方法从正压拔管改为常压拔管。因此，我们使用倾向得分分析比较了正压（2017 年 4 月 1 日至 2019 年 12 月 31 日）和常压拔管技术（2020 年 3 月 3 日至 2022 年 3 月 31 日）的术后肺炎风险。术后肺炎使用国际疾病分类第 10 版（ICD-10）代码（J13-J18）进行定义，我们审查了标有这些 ICD-10 代码（术前肺炎和肺炎预防性抗生素处方的 ICD-10 代码）的患者病历。结果我们确定了 20111 例手术，其中正压拔管组 11920 例（平均年龄 48.2 岁，标准差 [SD] 25.2 岁），常压拔管组 8091 例（平均年龄 47.8 岁，标准差 25.8 岁）。正压拔管组和常压拔管组的术后肺炎发病率分别为 0.19%（23/11,920 例）和 0.17%（14/8,091 例）。使用反概率加权法进行倾向评分分析后发现，两组的术后肺炎发生率无显著差异（调整后的几率比 0.98，95% 置信区间 0.50 至 1.91，P = 0.94）。结论这些结果表明，与正压拔管技术相比，常压拔管技术不会增加术后肺炎的风险：UMIN000048589 https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000055364

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来源期刊

Journal of Anesthesia 医学-麻醉学

CiteScore

5.30

自引率

7.10%

发文量

112

审稿时长

3-8 weeks

期刊介绍： The Journal of Anesthesia is the official journal of the Japanese Society of Anesthesiologists. This journal publishes original articles, review articles, special articles, clinical reports, short communications, letters to the editor, and book and multimedia reviews. The editors welcome the submission of manuscripts devoted to anesthesia and related topics from any country of the world. Membership in the Society is not a prerequisite. The Journal of Anesthesia (JA) welcomes case reports that show unique cases in perioperative medicine, intensive care, emergency medicine, and pain management.