Effect of intraoperative PEEP with recruitment maneuvers on the occurrence of postoperative pulmonary complications during general anesthesia--protocol for Bayesian analysis of three randomized clinical trials of intraoperative ventilation.

2022

Mazzinari, Guido

Zampieri, Fernando G

Ball, Lorenzo

Campos, Niklas S

Bluth, Thomas

Hemmes, Sabrine N T

Ferrando, Carlos

Librero, Julian

Soro, Marina

Pelosi, Paolo

Gama de Abreu, Marcelo

Schultz, Marcus J

Serpa Neto, Ary

Bayesian analysis

Mechanical ventilation

PEEP

intraoperative ventilation

postoperative pulmonary complications

recruitment maneuvers

Journal Article

0000-0001-7377-331X

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10.12688/f1000research.125861.1

Background: Using the frequentist approach, a recent meta-analysis of three randomized clinical trials in patients undergoing intraoperative ventilation during general anesthesia for major surgery failed to show the benefit of ventilation that uses high positive end-expiratory pressure with recruitment maneuvers when compared to ventilation that uses low positive end-expiratory pressure without recruitment maneuvers. Methods: We designed a protocol for a Bayesian analysis using the pooled dataset. The multilevel Bayesian logistic model will use the individual patient data. Prior distributions will be prespecified to represent a varying level of skepticism for the effect estimate. The primary endpoint will be a composite of postoperative pulmonary complications (PPC) within the first seven postoperative days, which reflects the primary endpoint of the original studies. We preset a range of practical equivalence to assess the futility of the intervention with an interval of odds ratio (OR) between 0.9 and 1.1 and assess how much of the 95% of highest density interval (HDI) falls between the region of practical equivalence. Ethics and dissemination: The used data derive from approved studies that were published in recent years. The findings of this current analysis will be reported in a new manuscript, drafted by the writing committee on behalf of the three research groups. All investigators listed in the original trials will serve as collaborative authors.

link

F1000Research 2022; 11

F1000Research

2046-1402