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. 2022 Oct 18:13:1032783.
doi: 10.3389/fimmu.2022.1032783. eCollection 2022.

Optimized ventilation strategy for surgery on patients with obesity from the perspective of lung protection: A network meta-analysis

Jing Wang  1   2   3 , Jie Zeng  1   2   3 , Chao Zhang  1   2   3 , Wenwen Zheng  1   2   3 , Xilu Huang  1   2   3 , Nan Zhao  1   2   3 , Guangyou Duan  4 , Cong Yu  1   2   3
Affiliations

Optimized ventilation strategy for surgery on patients with obesity from the perspective of lung protection: A network meta-analysis

Jing Wang et al. Front Immunol. .

Abstract

Objectives: New ventilation modes have been proposed to support the perioperative treatment of patients with obesity, but there is a lack of consensus regarding the optimal strategy. Therefore, a network meta-analysis update of 13 ventilation strategies was conducted to determine the optimal mode of mechanical ventilation as a protective ventilation strategy decreases pulmonary atelectasis caused by inflammation.

Methods: The following databases were searched: MEDLINE; Cochrane Library; Embase; CINAHL; Google Scholar; and Web of Science for randomized controlled trials of mechanical ventilation in patients with obesity published up to May 1, 2022.

Results: Volume-controlled ventilation with individualized positive end-expiratory pressure and a recruitment maneuver (VCV+PEEPind+RM) was found to be the most effective strategy for improving ratio of the arterial O2 partial pressure to the inspiratory O2 concentration (PaO2/FiO2), and superior to pressure-controlled ventilation (PCV), volume-controlled ventilation (VCV), volume-controlled ventilation with recruitment maneuver (VCV+RM), volume-controlled ventilation with low positive end-expiratory pressure (VCV+lowPEEP), volume-controlled ventilation with lower positive expiratory end pressure (PEEP) and recruitment maneuver (VCV+lowPEEP+RM), and the mean difference [MD], the 95% confidence intervals [CIs] and [quality of evidence] were: 162.19 [32.94, 291.45] [very low]; 180.74 [59.22, 302.27] [low]; 171.07 [40.60, 301.54] [very low]; 135.14 [36.10, 234.18] [low]; and 139.21 [27.08, 251.34] [very low]. Surface under the cumulative ranking curve (SUCRA) value showed VCV+PEEPind+RM was the best strategy for improving PaO2/FiO2 (SUCRA: 0.963). VCV with high positive PEEP and recruitment maneuver (VCV+highPEEP+RM) was more effective in decreasing postoperative pulmonary atelectasis than the VCV+lowPEEP+RM strategy. It was found that volume-controlled ventilation with high positive expiratory end pressure (VCV+highPEEP), risk ratio [RR] [95% CIs] and [quality of evidence], 0.56 [0.38, 0.81] [moderate], 0.56 [0.34, 0.92] [moderate]. SUCRA value ranked VCV+highPEEP+RM the best strategy for improving postoperative pulmonary atelectasis intervention (SUCRA: 0.933). It should be noted that the quality of evidence was in all cases very low or only moderate.

Conclusions: This research suggests that VCV+PEEPind+RM is the optimal ventilation strategy for patients with obesity and is more effective in increasing PaO2/FiO2, improving lung compliance, and among the five ventilation strategies for postoperative atelectasis, VCV+highPEEP+RM had the greatest potential to reduce atelectasis caused by inflammation.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021288941.

Keywords: immune response; inflammation; intraoperative ventilation strategy; obesity; pulmonary atelectasis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of literature search.
Figure 2
Figure 2
Network plots of main indicators. (A) PaO2/FiO2, (B) pulmonary atelectasis, (C) lung compliance.
Figure 3
Figure 3
League table of PaO2/FiO2 under different ventilation strategies.
Figure 4
Figure 4
League table of pulmonary complications under different ventilation strategies.
Figure 5
Figure 5
League table of pulmonary compliance under different ventilation strategies.
Figure 6
Figure 6
SUCRA ranking of the results in this meta-analysis.
See this image and copyright information in PMC

References

    1. Ogden CL, Yanovski SZ, Carroll MD, Flegal KM. The epidemiology of obesity. Gastroenterology (2007) 132(6):2087–102. doi: 10.1053/j.gastro.2007.03.052 - DOI - PubMed
    1. Zeng C, Lagier D, Lee J-W, Vidal Melo MF. Perioperative pulmonary atelectasis: Part I. Biol mech. Anesthesiol. (2022) 136(1):181–205. doi: 10.1097/ALN.0000000000003943 - DOI - PMC - PubMed
    1. Motta-Ribeiro GC, Hashimoto S, Winkler T, Baron RM, Grogg K, Paula LF, et al. . Deterioration of regional lung strain and inflammation during early lung injury. Am J Respir Crit Care Med (2018) 198(7):891–902. doi: 10.1164/rccm.201710-2038OC - DOI - PMC - PubMed
    1. Kisala JM, Ayala A, Stephan RN, Chaudry IH. A model of pulmonary atelectasis in rats: Activation of alveolar macrophage and cytokine release. Am J Physiol (1993) 264(3):R610–R4. doi: 10.1152/ajpregu.1993.264.3.R610 - DOI - PubMed
    1. Shennib H, Mulder DS, Chiu RC-J. The effects of pulmonary atelectasis and reexpansion on lung cellular immune defenses. Arch Surg (1984) 119(3):274–7. doi: 10.1001/archsurg.1984.01390150016004 - DOI - PubMed

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