Correspondence  |   November 2019
Driving Pressure–guided Ventilation: Comment
Author Notes
  • Memorial Sloan Kettering Cancer Center, New York, New York. amard@mskcc.org
  • (Accepted for publication July 24, 2019.)
    (Accepted for publication July 24, 2019.)×
Article Information
Correspondence
Correspondence   |   November 2019
Driving Pressure–guided Ventilation: Comment
Anesthesiology 11 2019, Vol.131, 1193-1194. doi:10.1097/ALN.0000000000002953
Anesthesiology 11 2019, Vol.131, 1193-1194. doi:10.1097/ALN.0000000000002953
I read with interest the randomized clinical trial by Park et al.1  on the novel approach of using driving pressure–guided ventilation during one-lung ventilation as a method to reduce postoperative pulmonary complications in comparison to conventional protective ventilation. There are several significant limitations to the study that impact interpretation of the results and conclusions. First, the inclusion of lung resection and esophagectomy patients in assessing the effects of driving pressure manipulations on combined pulmonary outcomes is the most important limitation of this study. In comparison to lung resections, esophagectomies are different in that preoperative chemoradiation is standard, the operation typically involves an abdominal and/or neck incision in addition to the thoracic approach, intraoperative ventilation includes a significant period of two-lung ventilation, and there are greater fluid requirements, as well as higher risks of aspiration and greater postoperative morbidity and mortality.2,3  The Society of Thoracic Surgeons (Chicago, Illinois) maintains two separate databases for these operations. For example, the reported incidence of pneumonia within 30 days of lung resection is 4.8% (1,116 of 27,844)2  and 12.2% (529 of 4,321)3  after esophagectomy. Similar to the authors’ efforts to focus on the effects of intraoperative ventilatory parameters during one-lung ventilation on the combined incidence of postoperative pneumonia and/or acute respiratory distress syndrome (ARDS), we reported an overall incidence of 4.0% (24 of 608) following anatomic lung resection.4  It would be more informative if the authors could share their outcome data by the type of surgery and not combined as presented even if the results were negative.