Effect of driving pressure-guided positive end-expiratory pressure on postoperative pulmonary complications in patients undergoing laparoscopic or robotic surgery: a randomised controlled trial.

BACKGROUND: Individualised positive end-expiratory pressure (PEEP) improves respiratory mechanics. However, whether PEEP reduces postoperative pulmonary complications (PPCs) remains unclear. We investigated whether driving pressure-guided PEEP reduces PPCs after laparoscopic/robotic abdominal surgery. METHODS: This single-centre, randomised controlled trial enrolled patients at risk for PPCs undergoing laparoscopic or robotic lower abdominal surgery. The individualised group received driving pressure-guided PEEP, whereas the comparator group received 5 cm H2O fixed PEEP during surgery. Both groups received a tidal volume of 8 ml kg-1 ideal body weight. The primary outcome analysed per protocol was a composite of pulmonary complications (defined by pre-specified clinical and radiological criteria) within 7 postoperative days after surgery. RESULTS: Some 384 patients (median age: 67 yr [inter-quartile range: 61-73]; 66 [18%] female) were randomised. Mean (standard deviation) PEEP in patients randomised to individualised PEEP (n=178) was 13.6 cm H2O (2.1). Individualised PEEP resulted in lower mean driving pressures (14.7 cm H2O [2.6]), compared with 185 patients randomised to standard PEEP (18.4 cm H2O [3.2]; mean difference: -3.7 cm H2O [95% confidence interval (CI): -4.3 to -3.1 cm H2O]; P<0.001). There was no difference in the incidence of pulmonary complications between individualised (25/178 [14.0%]) vs standard PEEP (36/185 [19.5%]; risk ratio [95% CI], 0.72 [0.45-1.15]; P=0.215). Pulmonary complications as a result of desaturation were less frequent in patients randomised to individualised PEEP (8/178 [4.5%], compared with standard PEEP (30/185 [16.2%], risk ratio [95% CI], 0.28 [0.13-0.59]; P=0.001). CONCLUSIONS: Driving pressure-guided PEEP did not decrease the incidence of pulmonary complications within 7 days of laparoscopic or robotic lower abdominal surgery, although uncertainty remains given the lower than anticipated event rate for the primary outcome. CLINICAL TRIAL REGISTRATION: KCT0004888 (http://cris.nih.go.kr, registration date: April 6, 2020).

Laser guidance for ultrasound-guided radial artery catheterization using smart glasses: a randomized trial.

PURPOSE: The use of smart glasses during ultrasound-guided needle procedures may reduce operators' head movements but has not been shown to improve procedural performance. Laser guidance has been shown to decrease the time required for ultrasound-guided procedures in phantom models but has not been tested clinically. We hypothesized that adding laser guidance to the use of smart glasses for ultrasound-guided radial artery catheterization using the long axis approach would improve performance by relatively inexperienced users unfamilar with these techniques. METHODS: In an unblinded controlled trial, we enrolled 52 patients requiring radial artery catheterization under anesthesia, randomized into two groups: smart glasses only (SO) (control; N = 26) or smart glasses with laser guidance group (SL) (N = 26). We assessed catheterization time (primary outcome), the number of needle redirections, first-pass success rate, and operator satisfaction (100 = most satisfactory; 0 = unsatisfactory). RESULTS: Comparing the SL with the SO group, catheterization time was shorter (median [interquartile range], 13 [9-20] sec vs 24 [18-46] sec, P < 0.001) and the number of needle redirections was lower (0 [0-1] vs 3 [1-3], P < 0.001) while the first-pass success rate (50% vs 12%, P = 0.007) and operator satisfaction score (85 [76-95] vs 52 [44-74], P < 0.001) were higher. CONCLUSION: Laser guidance improved the performance of ultrasound-guided radial artery catheterization using smart glasses in users inexperienced in the long axis in-plane approach. Nevertheless, it is unclear whether these findings are clinically significant. STUDY REGISTRATION DATE: CRIS.nih.go.kr (KCT0007168); registered 8 April 2022.

RéSUMé: OBJECTIF: L'utilisation de lunettes intelligentes pendant les procédures de ponctions échoguidées peut réduire les mouvements de la tête des opérateurs et opératrices, mais il n'a pas été démontré qu'elle améliorait les performances procédurales. Il a été démontré que le guidage laser réduisait le temps requis pour les interventions échoguidées sur des modèles fantômes, mais cette modalité n'a pas été testée cliniquement. Nous avons émis l'hypothèse que l'ajout d'un guidage laser à l'utilisation de lunettes intelligentes pour le cathétérisme échoguidé de l'artère radiale en utilisant une approche longitudinale (long axe) améliorerait les performances d'utilisateurs et utilisatrices relativement inexpérimenté·es et peu familier·ères avec ces techniques. MéTHODE: Dans une étude contrôlée sans insu, nous avons recruté et randomisé en deux groupes 52 patient·es nécessitant un cathétérisme de l'artère radiale sous anesthésie : lunettes intelligentes uniquement (LIU) (témoin N = 26) ou lunettes intelligentes avec guidage laser (LIL) (N = 26). Nous avons évalué le temps de cathétérisme (critère d'évaluation principal), le nombre de réorientation d'aiguilles, le taux de réussite au premier passage et la satisfaction de l'opérateur·trice (100 = le plus satisfaisant; 0 = insatisfaisant). RéSULTATS: En comparant le groupe LIL au groupe LIU, le temps de cathétérisme était plus court (médiane [écart interquartile], 13 [9-20] sec vs 24 [18­46] sec, P < 0,001) et le nombre de réorientations d'aiguilles était plus faible (0 [0­1] vs 3 [1­3], P < 0,001), tandis que le taux de réussite au premier passage (50 % vs 12 %, P = 0,007) et le score de satisfaction des opératrices et opérateurs (85 [76­95] vs 52 [44­74], P < 0,001) étaient plus élevés. CONCLUSION: Le guidage laser à l'aide de lunettes intelligentes a amélioré les performances du cathétérisme échoguidé de l'artère radiale chez des utilisateurs et utilisatrices inexpérimenté·es en approche longitudinale. Nous ne pouvons toutefois pas déterminer si ces résultats sont cliniquement significatifs. DATE D'ENREGISTREMENT DE L'éTUDE: CRIS.nih.go.kr (KCT0007168); enregistré le 8 avril 2022.