The combination of general anaesthesia with low tidal volume and moderate-to-high PEEP reduces post-operative pulmonary complications in the general surgical population.pearl
- Qi-Wen Deng, Wen-Cheng Tan, Bing-Cheng Zhao, Shi-Hong Wen, Jian-Tong Shen, and Miao Xu.
- Department of Anaesthesiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
- Br J Anaesth. 2020 Mar 1; 124 (3): 324-335.
BackgroundThe debate on lung-protective ventilation strategies for surgical patients is ongoing. Evidence suggests that the use of low tidal volume VT improves clinical outcomes. However, the optimal levels of PEEP and recruitment manoeuvre (RM) strategies incorporated into low VT ventilation remain unclear.MethodsSeveral electronic databases were searched to identify RCTs that focused on comparison between low VT strategy and conventional mechanical ventilation (CMV), or between two different low VT strategies in surgical patients. The primary outcome was postoperative pulmonary complications (PPCs). The secondary outcomes were atelectasis, pneumonia, acute respiratory distress syndrome, and short-term mortality. Bayesian network meta-analyses were performed using WinBUGS. The odds ratios (ORs) and corresponding 95% credible intervals (CrIs) were estimated.ResultsCompared with CMV, low VT ventilation with moderate-to-high PEEP reduced the risk of PPCs (moderate PEEP [5-8 cm H2O]: OR 0.50 [95% CrI: 0.28, 0.89]; moderate PEEP+RMs: 0.39 [0.19, 0.78]; and high PEEP [≥9 cm H2O]+RMs: 0.34 [0.14, 0.79]). Low VT ventilation with moderate-to-high PEEP and RMs also specifically reduced the risk of atelectasis compared with CMV (moderate PEEP+RMs: OR 0.36 [95% CrI: 0.16, 0.87]; and high PEEP+RMs: 0.41 [0.15, 0.97]), whilst low VT ventilation with moderate PEEP was superior to CMV in reducing the risk of pneumonia (OR 0.46 [95% CrI: 0.15, 0.94]).ConclusionsThe combination of low VT ventilation and moderate-to-high PEEP (≥5 cm H2O) seems to confer lung protection in surgical patients undergoing general anaesthesia.Clinical Trial RegistrationPROSPERO (CRD42019144561).Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
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