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http://hdl.handle.net/10553/123909
Title: | Intraoperative positive end-expiratory pressure and postoperative pulmonary complications: a patient-level meta-analysis of three randomised clinical trials | Authors: | Campos, Niklas S. Bluth, Thomas Hemmes, Sabrine NT Librero, Julian Pozo, Natividad Ferrando, Carlos Ball, Lorenzo Mazzinari, Guido Pelosi, Paolo Gamade de Abreu, Marcelo Schultz, Marcus J. Serpa Neto, A Rodríguez Pérez, Aurelio Eduardo |
UNESCO Clasification: | 32 Ciencias médicas 3213 Cirugía |
Keywords: | Mechanical ventilation PEEP Postoperative pulmonary complications Surgery |
Issue Date: | 2022 | Journal: | British journal of anaesthesia | Abstract: | Background: High intraoperative PEEP with recruitment manoeuvres may improve perioperative outcomes. We re-examined this question by conducting a patient-level meta-analysis of three clinical trials in adult patients at increased risk for postoperative pulmonary complications who underwent non-cardiothoracic and non-neurological surgery. Methods: The three trials enrolled patients at 128 hospitals in 24 countries from February 2011 to February 2018. All patients received volume-controlled ventilation with low tidal volume. Analyses were performed using one-stage, two-level, mixed modelling (site as a random effect; trial as a fixed effect). The primary outcome was a composite of postoperative pulmonary complications within the first week, analysed using mixed-effect logistic regression. Pre-specified subgroup analyses of nine patient characteristics and seven procedure and care-delivery characteristics were also performed. Results: Complete datasets were available for 1913 participants ventilated with high PEEP and recruitment manoeuvres, compared with 1924 participants who received low PEEP. The primary outcome occurred in 562/1913 (29.4%) participants randomised to high PEEP, compared with 620/1924 (32.2%) participants randomised to low PEEP (unadjusted odds ratio [OR]=0.87; 95% confidence interval [95% CI], 0.75–1.01; P=0.06). Higher PEEP resulted in 87/1913 (4.5%) participants requiring interventions for desaturation, compared with 216/1924 (11.2%) participants randomised to low PEEP (OR=0.34; 95% CI, 0.26–0.45). Intraoperative hypotension was associated more frequently (784/1913 [41.0%]) with high PEEP, compared with low PEEP (579/1924 [30.1%]; OR=1.87; 95% CI, 1.60–2.17). Conclusions: High PEEP combined with recruitment manoeuvres during low tidal volume ventilation in patients undergoing major surgery did not reduce postoperative pulmonary complications. | URI: | http://hdl.handle.net/10553/123909 | ISSN: | 0007-0912 | DOI: | 10.1016/j.bja.2022.02.039 | Source: | British Journal of Anaesthesia, [ISSN 0007-0912], v. 128, (6), p. 1040-1051, (2022). |
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