• Anesthesia and analgesia · Apr 2020

    Meta Analysis

    Positive End-Expiratory Pressure During Anesthesia for Prevention of Postoperative Pulmonary Complications: A Meta-analysis With Trial Sequential Analysis of Randomized Controlled Trials.

    It is still uncertain whether intraoperative PEEP actually reduces postoperative respiratory complications.

    pearl
    • Pengcheng Zhang, Lingmin Wu, Xuan Shi, Huanping Zhou, Meiyun Liu, Yuanli Chen, and Xin Lv.
    • From the Department of Anesthesiology, The First Hospital of Anhui Medical University, Hefei, China.
    • Anesth. Analg. 2020 Apr 1; 130 (4): 879-889.

    BackgroundWhether intraoperative positive end-expiratory pressure (PEEP) can reduce the risk of postoperative pulmonary complications remains controversial. We performed a systematic review of currently available literature to investigate whether intraoperative PEEP decreases pulmonary complications in anesthetized patients undergoing surgery.MethodsWe searched PubMed, Embase, and the Cochrane Library to identify randomized controlled trials (RCTs) that compared intraoperative PEEP versus zero PEEP (ZEEP) for postoperative pulmonary complications in adults. The prespecified primary outcome was postoperative pulmonary atelectasis.ResultsFourteen RCTs enrolling 1238 patients met the inclusion criteria. Meta-analysis using a random-effects model showed a decrease in postoperative atelectasis (relative risk [RR], 0.51; 95% confidence interval [CI], 0.35-0.76; trial sequential analyses [TSA]-adjusted CI, 0.10-2.55) and postoperative pneumonia (RR, 0.48; 95% CI, 0.27-0.84; TSA-adjusted CI, 0.05-4.86) in patients receiving PEEP ventilation. However, TSA showed that the cumulative Z-curve of 2 outcomes crossed the conventional boundary but did not cross the trial sequential monitoring boundary, indicating a possible false-positive result. We observed no effect of PEEP versus ZEEP ventilation on postoperative mortality (RR, 1.78; 95% CI, 0.55-5.70).ConclusionsThe evidence that intraoperative PEEP reduces postoperative pulmonary complications is suggestive but too unreliable to allow definitive conclusions to be drawn.

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    pearl
    1

    It is still uncertain whether intraoperative PEEP actually reduces postoperative respiratory complications.

    Daniel Jolley  Daniel Jolley
     
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