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. 2024 Sep 28;24(1):346.
doi: 10.1186/s12871-024-02737-w.

Effects of lung protection ventilation strategies on postoperative pulmonary complications after noncardiac surgery: a network meta-analysis of randomized controlled trials

Jun Mo #  1 , Dan Wang #  2 , Jingyu Xiao  1 , Qi Chen  1 , Ran An  3 , Hong Liang Liu  4
Affiliations

Effects of lung protection ventilation strategies on postoperative pulmonary complications after noncardiac surgery: a network meta-analysis of randomized controlled trials

Jun Mo et al. BMC Anesthesiol. .

Abstract

Background: The purpose of this network meta-analysis was to assess the impact of different protective ventilatory strategies on postoperative pulmonary complications (PPCs).

Methods: Several databases were searched for randomized controlled trials (RCTs) that were published before October 2023 in a network meta-analysis. We assessed the effect of different lung-protective ventilation strategies on the incidence of PPCs using Bayesian network meta-analysis.

Results: We included 58 studies (11610 patients) in this meta-analysis. The network meta-analysis showed that low tidal volumes (LTVs) combined with iPEEP and recruitment manoeuvres (RM) was associated with significantly lower incidence of PPCs [HTVs: OR = 0.38, 95%CrI (0.19, 0.75), LTVs: OR = 0.33, 95%CrI (0.12, 0.82)], postoperative atelectasis[HTVs: OR = 0.2, 95%CrI (0.08, 0.48), LTVs: OR = 0.47, 95%CrI (0.11, 0.93)], and pneumonia[HTVs: OR = 0.22, 95%CrI (0.09, 0.48), LTVs: OR = 0.27, 95%CrI (0.08,0.89)] than was High tidal volumes (HTVs) or LTVs. LTVs combined with medium-to-high PEEP and RM were associated with significantly lower incidence of postoperative atelectasis, and pneumonia.

Conclusion: LTVs combined with iPEEP and RM decreased the incidence of PPCs, postoperative atelectasis, and pneumonia in noncardiac surgery patients. Individual PEEP-guided ventilation was the optimal lung protection ventilation strategy. The quality of evidence is moderate.

Trial registration: PROSPERO identifier CRD42023399485.

Keywords: Mechanical ventilation; Network meta-analysis; Postoperative complications.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of literature screening
Fig. 2
Fig. 2
Network geometry plot (LTVs: low tidal volumes, HTVs: high tidal volumes, iPEEP: individual positive end-expiratory pressure, HPEEP: high positive end-Expiratory pressure, MPEEP: moderate positive end-expiratory pressure, LPEEP: low positive end-expiratory pressure, RM: recruitment manoeuvres, URM: ultrasound-guided recruitment manoeuvres. The width of the lines represents the cumulative number of RCTs for each pairwise comparison and the size of every node is proportional to the number of randomized participants.)
Fig. 3
Fig. 3
The plot of cumulative ranking curve (LTVs: low tidal volumes, HTVs: high tidal volumes, iPEEP: individual positive end-expiratory pressure, HPEEP: high positive end-Expiratory pressure, MPEEP: moderate positive end-expiratory pressure, LPEEP: low positive end-expiratory pressure, RM: recruitment manoeuvres, URM: ultrasound-guided recruitment manoeuvres. The area under the curve is proportional to SUCRA.)
See this image and copyright information in PMC

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References

    1. Fernandez-Bustamante A, Frendl G, Sprung J, Kor DJ, Subramaniam B, Martinez Ruiz R, Lee JW, Henderson WG, Moss A, Mehdiratta N, et al. Postoperative pulmonary complications, early mortality, and Hospital Stay following noncardiothoracic surgery: a Multicenter Study by the Perioperative Research Network Investigators. JAMA Surg. 2017;152(2):157–66. - PMC - PubMed
    1. investigators LV: Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - an observational study in 29 countries. Eur J Anaesthesiol 2017, 34(8):492–507. - PMC - PubMed
    1. Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, Kairalla RA, Deheinzelin D, Munoz C, Oliveira R, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998;338(6):347–54. - PubMed
    1. Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M, Schoenfeld D, Thompson BT, National Heart L, Blood Institute ACTN. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med. 2004;351(4):327–36. - PubMed
    1. Young CC, Harris EM, Vacchiano C, Bodnar S, Bukowy B, Elliott RRD, Migliarese J, Ragains C, Trethewey B, Woodward A, et al. Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations. Br J Anaesth. 2019;123(6):898–913. - PubMed

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