Intraoperative positive end-expiratory pressure and postoperative pulmonary complications: a patient-level meta-analysis of three randomised clinical trials.

Autor:	Campos NS; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Cardio-Pulmonary Department, Pulmonary Division, Faculdade de Medicina, Instituto do Coração, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil., Bluth T; Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany., Hemmes SNT; Department of Intensive Care, Amsterdam University Medical Centers, location 'AMC', Amsterdam, the Netherlands; Department of Anesthesiology, Amsterdam University Medical Centers, location 'AMC', Amsterdam, the Netherlands., Librero J; Navarrabiomed-Fundación Miguel Servet, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain., Pozo N; INCLIVA Clinical Research Institute, Hospital Clinico Universitario de Valencia, Valencia, Spain., Ferrando C; Department of Anesthesiology & Critical Care, Hospital Clinico Universitario de Valencia, Valencia, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain., Ball L; Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinico Hospital - IRCCS for Oncology, University of Genoa, Genoa, Italy., Mazzinari G; Research Group in Perioperative Medicine, Hospital Universitario y Politécnico la Fe, Valencia, Spain; Department of Anesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain., Pelosi P; Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinico Hospital - IRCCS for Oncology, University of Genoa, Genoa, Italy., Gama de Abreu M; Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany., Schultz MJ; Department of Intensive Care, Amsterdam University Medical Centers, location 'AMC', Amsterdam, the Netherlands; 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; Mahidol Oxford Research Unit (MORU), Mahidol University, Bangkok, Thailand., Serpa Neto A; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Cardio-Pulmonary Department, Pulmonary Division, Faculdade de Medicina, Instituto do Coração, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil; Department of Intensive Care, Amsterdam University Medical Centers, location 'AMC', Amsterdam, the Netherlands; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia. Electronic address: ary.neto2@einstein.br.
Jazyk:	angličtina
Zdroj:	British journal of anaesthesia [Br J Anaesth] 2022 Jun; Vol. 128 (6), pp. 1040-1051. Date of Electronic Publication: 2022 Apr 15.
DOI:	10.1016/j.bja.2022.02.039
Abstrakt:	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. Clinical Trial Registration: NCT03937375 (Clinicaltrials.gov). (Copyright © 2022 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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