Intraoperative ventilation strategies to prevent postoperative pulmonary complications: a network meta-analysis of randomised controlled trials.

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2020
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Abstract
The debate on lung-protective ventilation strategies for surgical patients is ongoing. Evidence suggests that the use of low tidal volume V improves clinical outcomes. However, the optimal levels of PEEP and recruitment manoeuvre (RM) strategies incorporated into low V ventilation remain unclear.Several electronic databases were searched to identify RCTs that focused on comparison between low V strategy and conventional mechanical ventilation (CMV), or between two different low V strategies in surgical patients. The primary outcome was postoperative pulmonary complications (PPCs). The secondary outcomes were atelectasis, pneumonia, acute respiratory distress syndrome, and short-term mortality. Bayesian network meta-analyses were performed using WinBUGS. The odds ratios (ORs) and corresponding 95% credible intervals (CrIs) were estimated.Compared with CMV, low V ventilation with moderate-to-high PEEP reduced the risk of PPCs (moderate PEEP [5-8 cm HO]: OR 0.50 [95% CrI: 0.28, 0.89]; moderate PEEP+RMs: 0.39 [0.19, 0.78]; and high PEEP [≥9 cm HO]+RMs: 0.34 [0.14, 0.79]). Low V ventilation with moderate-to-high PEEP and RMs also specifically reduced the risk of atelectasis compared with CMV (moderate PEEP+RMs: OR 0.36 [95% CrI: 0.16, 0.87]; and high PEEP+RMs: 0.41 [0.15, 0.97]), whilst low V ventilation with moderate PEEP was superior to CMV in reducing the risk of pneumonia (OR 0.46 [95% CrI: 0.15, 0.94]).The combination of low V ventilation and moderate-to-high PEEP (≥5 cm HO) seems to confer lung protection in surgical patients undergoing general anaesthesia.PROSPERO (CRD42019144561).
Reference Key
deng2020intraoperativebritish Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Deng, Qi-Wen;Tan, Wen-Cheng;Zhao, Bing-Cheng;Wen, Shi-Hong;Shen, Jian-Tong;Xu, Miao;
Journal British journal of anaesthesia
Year 2020
DOI
S0007-0912(19)30967-5
URL
Keywords
surgery mechanical ventilation positive end-expiratory pressure pulmonary complications recruitment manoeuvre tidal volume ventilation

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