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https://ahro.austin.org.au/austinjspui/handle/1/30214| Title: | Intraoperative positive end-expiratory pressure and postoperative pulmonary complications: a patient-level meta-analysis of three randomised clinical trials. | Austin Authors: | Campos, Niklas S;Bluth, Thomas;Hemmes, Sabrine N T;Librero, Julian;Pozo, Natividad;Ferrando, Carlos;Ball, Lorenzo;Mazzinari, Guido;Pelosi, Paolo;Gama de Abreu, Marcelo;Schultz, Marcus J;Serpa Neto, Ary | Affiliation: | Medicine (University of Melbourne) Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia Coração, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil Mahidol Oxford Research Unit (MORU), Mahidol University, Bangkok, Thailand Department of Intensive Care, Amsterdam University Medical Centers, location 'AMC', Amsterdam, the Netherlands; Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany Department of Anesthesiology, Amsterdam University Medical Centers, location 'AMC', Amsterdam, the Netherlands Navarrabiomed-Fundación Miguel Servet, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain INCLIVA Clinical Research Institute, Hospital Clinico Universitario de Valencia, Valencia, Spain Department of Anesthesiology & Critical Care, Hospital Clinico Universitario de Valencia, Valencia, Spain Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinico Hospital - IRCCS for Oncology, University of Genoa, Genoa, Italy Research Group in Perioperative Medicine, Hospital Universitario y Politécnico la Fe, Valencia, Spain Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Centers, location 'AMC', Amsterdam, the Netherlands Nuffield Department of Medicine, University of Oxford, Oxford, UK Cardio-Pulmonary Department, Pulmonary Division, Faculdade de Medicina, Instituto do CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain Department of Anesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain |
Issue Date: | Jun-2022 | Date: | 2022-04-15 | Publication information: | British Journal of Anaesthesia 2022; 128(6): 1040-1051 | Abstract: | 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. 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. 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). High PEEP combined with recruitment manoeuvres during low tidal volume ventilation in patients undergoing major surgery did not reduce postoperative pulmonary complications. NCT03937375 (Clinicaltrials.gov). | URI: | https://ahro.austin.org.au/austinjspui/handle/1/30214 | DOI: | 10.1016/j.bja.2022.02.039 | ORCID: | 0000-0003-1520-9387 | Journal: | British Journal of Anaesthesia | PubMed URL: | 35431038 | PubMed URL: | https://pubmed.ncbi.nlm.nih.gov/35431038/ | Type: | Journal Article | Subjects: | PEEP mechanical ventilation postoperative pulmonary complications surgery |
| Appears in Collections: | Journal articles |
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