Work

Efficacy and safety of lung-protective ventilation in neurosurgery: a systematic review and meta-analysis of randomized controlled clinical trials

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Methods We systematically searched the PubMed, Embase, the Cochrane Library, and WANFANG databases (2000–2025) for randomized controlled trials (RCTs) comparing lung-protective ventilation (LPV) with conventional ventilation in craniotomy patients. The primary outcome was the incidence of overall postoperative pulmonary complications (PPCs). The secondary outcomes included intracranial pressure (ICP), pulmonary infection, atelectasis, oxygenation index, and lung compliance. All analyses were performed using Review Manager 5.2. Results Seven RCTs involving 523 patients were included in the study. Compared to conventional ventilation, LPV significantly reduced the risk of overall PPCs (OR 0.30, 95% CI: 0.18–0.48, p < 0.00001, I 2 = 0%), without increasing the optic nerve sheath diameter (ONSD)—a surrogate measure for ICP either before dual opening (MD: -0.01, 95%CI: −0.04–0.02, p = 0.45, I 2 = 0%) or at the end of surgery (MD: −0.04, 95%CI: −0.10–0.02, p = 0.21, I 2 = 0%). LPV significantly improved lung compliance (MD: 1.81, 95%CI: 0.79–2.84, p = 0.0005, I 2 = 81%) and oxygenation (MD: 40.28 mmHg, 95%CI: 24.93–56.03, p < 0.00001, I 2 = 59%) at the end of surgery, while also decreasing the risk of postoperative pulmonary infection (OR: 0.36, 95%CI: 0.22–0.59, p < 0.0001, I 2 = 12%) and atelectasis (OR: OR: 0.15, 95%CI: 0.08–0.30, p < 0.00001, I 2 = 14%). Conclusion This meta-analysis demonstrates that LPV effectively reduces PPCs (moderate-quality evidence) and does not elevate ICP (low- to moderate-quality evidence). Although conclusions regarding ICP are based on surrogate measures, further large-scale RCTs with standardized measures of invasive ICP and consistent definitions of PPCs and LPV are required to validate our findings.

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2026.1803798

Authors: Yan Liu, Qian Cao, Qian-Yun Pang, Hongliang Liu

Institutions: Zhuhai People's Hospital, Chongqing University, Chongqing Cancer Hospital

Language: English

Topic: Respiratory Support and Mechanisms

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801