Intraoperative ventilatory strategies to prevent postoperative pulmonary complications: A meta-analysis

Sabrine N.T. Hemmes, Ary Serpa Neto, Marcus J. Schultz

Research output: Contribution to journalReview ArticleResearchpeer-review

87 Citations (Scopus)

Abstract

Purpose of Review: It is uncertain whether patients undergoing short-lasting mechanical ventilation for surgery benefit from lung-protective intraoperative ventilatory settings including the use of lower tidal volumes, higher levels of positive end-expiratory pressure (PEEP) and/or recruitment maneuvers. We meta-analyzed trials testing the effect of lung-protective intraoperative ventilatory settings on the incidence of postoperative pulmonary complications. Recent Findings: Eight articles (1669 patients) were included. Meta-analysis showed a decrease in lung injury development [risk ratio (RR) 0.40; 95% confidence interval (CI) 0.22-0.70; I 0%; number needed to treat (NNT) 37], pulmonary infection (RR 0.64; 95% CI 0.43-0.97; I 0%; NNT 27) and atelectasis (RR 0.67; 95% CI 0.47-0.96; I 48%; NNT 31) in patients receiving intraoperative mechanical ventilation with lower tidal volumes. Meta-analysis also showed a decrease in lung injury development (RR 0.29; 95% CI 0.14-0.60; I 0%; NNT 29), pulmonary infection (RR 0.62; 95% CI 0.40-0.96; I 15%; NNT 33) and atelectasis (RR 0.61; 95% CI 0.41-0.91; I 0%; NNT 29) in patients ventilated with higher levels of PEEP, with or without recruitment maneuvers. Summary: Lung-protective intraoperative ventilatory settings have the potential to protect against postoperative pulmonary complications.

Original languageEnglish
Pages (from-to)126-133
Number of pages8
JournalCurrent Opinion in Anaesthesiology
Volume26
Issue number2
DOIs
Publication statusPublished - 1 Apr 2013
Externally publishedYes

Keywords

  • intraoperative
  • mechanical ventilation
  • positive end-expiratory pressure
  • postoperative complications
  • tidal volume

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