Impact of ventilation strategies on pulmonary and cardiovascular complications in patients undergoing general anaesthesia for elective surgery: a systematic review and meta-analysis

被引:9
|
作者
Buonanno, Pasquale [1 ]
Marra, Annachiara [1 ]
Iacovazzo, Carmine [1 ]
Vargas, Maria [1 ]
Coviello, Antonio [1 ]
Squillacioti, Francesco [1 ]
Nappi, Serena [1 ]
de Siena, Andrea Uriel [1 ]
Servillo, Giuseppe [1 ]
机构
[1] Univ Naples Federico II, Dept Neurosci Reprod Sci & Odontostomatol Sci, Naples, Italy
关键词
driving pressure; general anaesthesia; positive end-expiratory pressure; postoperative pulmonary compli-cations; ventilation strategy; END-EXPIRATORY PRESSURE; LOW-TIDAL-VOLUME; MECHANICAL VENTILATION; ABDOMINAL-SURGERY; DRIVING PRESSURE; BARIATRIC SURGERY; ORGAN DYSFUNCTION; SURGICAL-PATIENTS; LUNG INJURY; ATELECTASIS;
D O I
10.1016/j.bja.2023.09.011
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: Many RCTs have evaluated the influence of intraoperative tidal volume (tV), PEEP, and driving pressure on the occurrence of postoperative pulmonary complications, cardiovascular complications, and mortality in adult patients. Our meta-analysis aimed to investigate the association between tV, PEEP, and driving pressure and the above-mentioned outcomes.Methods: We conducted a systematic review and meta-analysis of RCTs from inception to May 19, 2022. The primary outcome was the incidence of postoperative pulmonary complications; the secondary outcomes were intraoperative cardiovascular complications and 30-day mortality. Primary and secondary outcomes were evaluated stratifying patients in the following groups: (1) low tV (LV, tV 6-8 ml kg(-1) and PEEP >= 5 cm H2O) vs high tV (HV, tV >8 ml kg(-1) and PEEP=0 cm H2O); (2) higher PEEP (HP, >= 6 cm H2O) vs lower PEEP (LP, <6 cm H2O); and (3) driving pressure-guided PEEP (DP) vs fixed PEEP (FP).Results: We included 16 RCTs with a total sample size of 4993. The incidence of postoperative pulmonary complications was lower in patients treated with LV than with HV (OR=0.402, CI 0.280-0.577, P<0.001) and lower in DP than in FP group (OR=0.358, CI 0.187-0.684, P=0.002). Postoperative pulmonary complications did not differ between HP and LP groups; the incidence of intraoperative cardiovascular complications was higher in HP group (OR=1.385, CI 1.027-1.867, P=0.002). The 30-day mortality was not influenced by the ventilation strategy.Conclusions: Optimal intraoperative mechanical ventilation is unclear; however, our meta-analysis showed that low tidal volume and driving pressure-guided PEEP strategies were associated with a reduction in postoperative pulmonary complications.
引用
收藏
页码:1093 / 1101
页数:9
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