Intraoperative ventilation strategies for obese patients undergoing bariatric surgery: systematic review and meta-analysis
| Autor: | Gianni Mara Silva dos Santos, Tamara Melnik, George Márcio Costa Souza, Sandra Adriana Zimpel |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Bariatric Surgery Respiratory physiology Mean airway pressure law.invention lcsh:RD78.3-87.3 03 medical and health sciences Plateau pressure Mechanical ventilation 0302 clinical medicine Randomized controlled trial 030202 anesthesiology law Anesthesiology medicine Humans Obesity 030212 general & internal medicine Continuous positive airway pressure Intraoperative Care business.industry respiratory system Respiration Artificial respiratory tract diseases Surgery Meta-analysis Anesthesiology and Pain Medicine lcsh:Anesthesiology Systematic review Breathing business Research Article circulatory and respiratory physiology |
| Zdroj: | BMC Anesthesiology, Vol 20, Iss 1, Pp 1-10 (2020) BMC Anesthesiology |
| ISSN: | 1471-2253 |
| DOI: | 10.1186/s12871-020-0936-y |
| Popis: | BackgroundObesity is a global epidemic, and it is widely known that increased Body mass index (BMI) is associated with alterations in respiratory mechanics. Bariatric surgery is established as an effective treatment for this condition.ObjectiveTo assess the safety and effectiveness of different ventilation strategies in obese patients undergoing bariatric surgery.MethodsA systematic review of randomized clinical trials aimed at evaluating ventilation strategies for obese patients was carried out. Primary outcomes: in-hospital mortality, adequacy of gas exchange, and respiration mechanics alterations.ResultsFourteen clinical trials with 574 participants were included. When recruitment maneuvers (RM) vs Positive end-expiratory pressure (PEEP) were compared, RM resulted in better oxygenationp = 0.03 (MD 79.93), higher plateau pressurep p = 0.001 (MD 167.00); when comparing Continuous Positive Airway Pressure (CPAP) 40 cmH2O + PEEP 10 cmH2O vs CPAP 40 cmH2O + PEEP 15 cmH2O, CPAP 40 + PEEP 15 achieved better gas exchangep = 0.003 (MD 36.00) and compliancep = 0.0003 (MD 3.00).ConclusionThere is some evidence that the alveolar recruitment maneuvers associated with PEEP lead to better oxygenation and higher compliance. There is no evidence of differences between pressure control ventilation (PCV) and Volume control ventilation (VCV). |
| Databáze: | OpenAIRE |
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