Effect Of Driving Pressure-Oriented Mechanical Ventilation On Postoperative Pulmonary Complications In Middle-Aged And Elderly Patients Undergoing Spinal Surgery

Objective:To explore whether driving pressure-oriented mechanical ventilation can improve intraoperative oxygenation and reduce the incidence of postoperative pulmonary complications after posterior spinal surgery in middle-aged and elderly people,and explore whether driving pressure can be used as an effective reference index for respiratory mechanics to guide mechanical ventilation to find the optimal positive end expiratory pressure for pulmonary ventilation in patients with posterior spinal surgery.Methods:A total of 160 cases of middle-aged and elderly patients who met the inclusion criteria were selected for prone spinal surgery.The selected patients were randomly divided into the driving pressure titration positive end expiratory pressure group（P group）and the lung protection ventilation control group（C group）with a fixed positive end expiratory pressure of 5cm H₂0.After the patient entered the room,the basic vital signs（ECG,Heart rate,Mean arterial pressure,Blood oxygen saturation）were collected and recorded.During the perioperative period,the blood gas results of the patient at four time points should be measured:（1）the patient was not inhaled oxygen when entering the room（T₀）,（2）the anesthesia induced mechanical ventilation was prone at 15 minutes after surgery（T₁）;（3）at 15 minutes before the end of the operation（T₂）;（4）after admission to the ward（T₃）,record airway peak pressure,driving pressure,Airway plateau pressur,End-tidal carbon dioxide partial pressure,and pulmonary dynamic compliance at T₁and T₂.The primary endpoint of the study was the incidence of intraoperative oxygenation and 7-day postoperative pulmonary complications.Results:The positive end expiratory pressure value of group P was（7.03±1.08）cm H₂0,the peak at T₁and T₂was higher than that of group C（P<0.05）,the driving pressure was lower than that of group C（P<0.05）.The Blood oxygen saturation and Oxygenation Index in group P at T₂were significantly higher than those in group C（P<0.05）.No serious postoperative pulmonary complications occurred in both groups P and C,but the incidence of postoperative pulmonary complications in group P was significantly lower than that in group C（P<0.05）.Conclusion:Driving pressure-oriented titration of positive end expiratory pressure can reduce the driving pressure of mechanical ventilation in middle-aged and elderly patients undergoing posterior spinal surgery,improve oxygenation and reduce the incidence of postoperative pulmonary complications in prone position surgery in the middle-aged and elderly.