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

Year: 2024
Type: review
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.
DOI: 10.1186/s12871-024-02737-w
Authors: Jun Mo, Dan Wang, Jingyu Xiao, Qi Chen, Ran An, Hong Liang Liu
Language: English
Field: Medicine
Open Access status: gold
Estimated APC paid: $2,990
OpenAlex ID: W4402936584
FWCI: 0.835
Cites: 45
Cited by: 7
Related to: 10