1. Protective versus Conventional Ventilation for Surgery: A Systematic Review and Individual Patient Data Meta-analysis
- Author
-
Serpa Neto, Ary, Hemmes, Sabrine N. T., Barbas, Carmen S. V., Beiderlinden, Martin, Biehl, Michelle, Binnekade, Jan M., Canet, Jaume, Fernandez-Bustamante, Ana, Futier, Emmanuel, Gajic, Ognjen, Hedenstierna, Göran, Hollmann, Markus W., Jaber, Samir, Kozian, Alf, Licker, Marc, Lin, Wen-Qian, Maslow, Andrew D., Memtsoudis, Stavros G., Reis Miranda, Dinis, Moine, Pierre, Thomas, Ng, Paparella, Domenico, Putensen, Christian, Ranieri, Marco, Scavonetto, Federica, Schilling, Thomas, Schmid, Werner, Selmo, Gabriele, Severgnini, Paolo, Sprung, Juraj, Sundar, Sugantha, Talmor, Daniel, Treschan, Tanja, Unzueta, Carmen, Weingarten, Toby N., Wolthuis, Esther K., Wrigge, Hermann, Gama De Abreu, Marcelo, Pelosi, Paolo, Schultz, Marcus J., University of Amsterdam [Amsterdam] (UvA), Mayo Clinic [Rochester], CHU Clermont-Ferrand, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Otto-von-Guericke University [Magdeburg] (OVGU), University of Bari Aldo Moro (UNIBA), University of Insubria, Varese, Intensive Care, Serpa Neto, A., Hemmes, S.N.T., Barbas, C.S.V., Beiderlinden, M., Biehl, M., Binnekade, J.M., Canet, J., Fernandez-Bustamante, A., Futier, E., Gajic, O., Hedenstierna, G., Hollmann, M.W., Jaber, S., Kozian, A., Licker, M., Lin, W.-Q., Maslow, A.D., Memtsoudis, S.G., Reis Miranda, D., Moine, P., Ng, T., Paparella, D., Putensen, C., Ranieri, M., Scavonetto, F., Schilling, T., Schmid, W., Selmo, G., Severgnini, P., Sprung, J., Sundar, S., Talmor, D., Treschan, T., Unzueta, C., Weingarten, T.N., Wolthuis, E.K., Wrigge, H., Gama De Abreu, M., Pelosi, P., Schultz, M.J., Intensive Care Medicine, AII - Amsterdam institute for Infection and Immunity, Anesthesiology, Other Research, and ACS - Amsterdam Cardiovascular Sciences
- Subjects
general surgery ,ventilator ,procedure ,statistic ,[SDV]Life Sciences [q-bio] ,Statistics as Topic ,Article ,tidal volume, Human ,Positive-Pressure Respiration ,systematic review ,dose response ,patient coding ,lung complication ,Tidal Volume ,Humans ,postoperative complication ,human ,randomized controlled trial (topic) ,comparative study ,ComputingMilieux_MISCELLANEOUS ,Randomized Controlled Trials as Topic ,meta analysi ,Respiration ,standard ,artificial ventilation ,Respiration, Artificial ,Anesthesiology and Pain Medicine ,priority journal ,risk factor ,positive end expiratory pressure ,Artificial ,physiology - Abstract
Background: Recent studies show that intraoperative mechanical ventilation using low tidal volumes (V-T) can prevent postoperative pulmonary complications (PPCs). The aim of this individual patient data meta-analysis is to evaluate the individual associations between V-T size and positive end-expiratory pressure (PEEP) level and occurrence of PPC. Methods: Randomized controlled trials comparing protective ventilation (low V-T with or without high levels of PEEP) and conventional ventilation (high V-T with low PEEP) in patients undergoing general surgery. The primary outcome was development of PPC. Predefined prognostic factors were tested using multivariate logistic regression. Results: Fifteen randomized controlled trials were included (2,127 patients). There were 97 cases of PPC in 1,118 patients (8.7%) assigned to protective ventilation and 148 cases in 1,009 patients (14.7%) assigned to conventional ventilation (adjusted relative risk, 0.64; 95% CI, 0.46 to 0.88; P < 0.01). There were 85 cases of PPC in 957 patients (8.9%) assigned to ventilation with low V-T and high PEEP levels and 63 cases in 525 patients (12%) assigned to ventilation with low V-T and low PEEP levels (adjusted relative risk, 0.93; 95% CI, 0.64 to 1.37; P = 0.72). A dose-response relationship was found between the appearance of PPC and V-T size (R-2 = 0.39) but not between the appearance of PPC and PEEP level (R-2 = 0.08). Conclusions: These data support the beneficial effects of ventilation with use of low V-T in patients undergoing surgery. Further trials are necessary to define the role of intraoperative higher PEEP to prevent PPC during nonopen abdominal surgery.
- Published
- 2015
- Full Text
- View/download PDF