Protective versus Conventional Ventilation for Surgery A Systematic Review and Individual Patient Data Meta-analysis
Por:
Neto, AS, Hemmes, SNT, Barbas, CSV, Beiderlinden, M, Biehl, M, Binnekade, JM, Canet, J, Fernandez-Bustamante, A, Futier, E, Gajic, O, Hedenstierna, G, Hollmann, MW, Jaber, S, Kozian, A, Licker, M, Lin, WQ, Maslow, AD, Memtsoudis, SG, Miranda, DR, Moine, P, Ng, T, Paparella, D, Putensen, C, Ranieri, M, Scavonetto, F, Schilling, T, Schmid, W, Selmo, G, Severgnini, P, Sprung, J, Sundar, S, Talmor, D, Treschan, T, Unzueta, C, Weingarten, TN, Wolthuis, EK, Wrigge, H, de Abreu, MG, Pelosi, P, Schultz, MJ
Publicada:
1 jul 2015
Resumen:
Background: Recent studies show that intraoperative mechanical ventilation using low tidal volumes (V-T) can prevent postoperative pulmonary complications (PPCs). The aim of this individual patient data meta-analysis is to evaluate the individual associations between V-T size and positive end-expiratory pressure (PEEP) level and occurrence of PPC.
Methods: Randomized controlled trials comparing protective ventilation (low V-T with or without high levels of PEEP) and conventional ventilation (high V-T with low PEEP) in patients undergoing general surgery. The primary outcome was development of PPC. Predefined prognostic factors were tested using multivariate logistic regression.
Results: Fifteen randomized controlled trials were included (2,127 patients). There were 97 cases of PPC in 1,118 patients (8.7%) assigned to protective ventilation and 148 cases in 1,009 patients (14.7%) assigned to conventional ventilation (adjusted relative risk, 0.64; 95% CI, 0.46 to 0.88; P < 0.01). There were 85 cases of PPC in 957 patients (8.9%) assigned to ventilation with low V-T and high PEEP levels and 63 cases in 525 patients (12%) assigned to ventilation with low V-T and low PEEP levels (adjusted relative risk, 0.93; 95% CI, 0.64 to 1.37; P = 0.72). A dose-response relationship was found between the appearance of PPC and V-T size (R-2 = 0.39) but not between the appearance of PPC and PEEP level (R-2 = 0.08).
Conclusions: These data support the beneficial effects of ventilation with use of low V-T in patients undergoing surgery. Further trials are necessary to define the role of intraoperative higher PEEP to prevent PPC during nonopen abdominal surgery.
Filiaciones:
Neto, AS:
Univ Amsterdam, Acad Med Ctr, Dept Intens Care, NL-1105 AZ Amsterdam, Netherlands
Univ Sao Paulo, Heart Inst INCOR, Fac Med, Dept Pneumol,Hosp Clin, Sao Paulo, Brazil
Hosp Israelita Albert Einstein, Dept Crit Care Med, Sao Paulo, Brazil
Hemmes, SNT:
Univ Amsterdam, Acad Med Ctr, Dept Intens Care, NL-1105 AZ Amsterdam, Netherlands
Barbas, CSV:
Univ Sao Paulo, Heart Inst INCOR, Fac Med, Dept Pneumol,Hosp Clin, Sao Paulo, Brazil
Hosp Israelita Albert Einstein, Dept Crit Care Med, Sao Paulo, Brazil
Beiderlinden, M:
Dusseldorf Univ Hosp, Dept Anaesthesiol, Dusseldorf, Germany
Marien Hosp, Dept Anaesthesiol, Osnabruck, Germany
Biehl, M:
Mayo Clin, Div Pulm & Crit Care Med, Rochester, MN USA
Binnekade, JM:
Univ Amsterdam, Acad Med Ctr, Dept Intens Care, NL-1105 AZ Amsterdam, Netherlands
Canet, J:
Univ Hosp, Dept Anesthesiol, Barcelona, Spain
Germans Trias & Pujol, Barcelona, Spain
Fernandez-Bustamante, A:
Univ Colorado, Dept Anesthesiol, Aurora, CO USA
Futier, E:
Estaing Univ Hosp, Dept Anesthesiol & Crit Care Med, Clermont Ferrand, France
Gajic, O:
Mayo Clin, Div Pulm & Crit Care Med, Rochester, MN USA
Hedenstierna, G:
Univ Uppsala Hosp, Dept Med Sci, Sect Clin Physiol, Uppsala, Sweden
Hollmann, MW:
Univ Amsterdam, Acad Med Ctr, Dept Intens Care, NL-1105 AZ Amsterdam, Netherlands
Jaber, S:
St Eloi Univ Hosp, Dept Crit Care Med & Anesthesiol SAR B, Montpellier, France
Kozian, A:
Univ Magdeburg, Dept Anesthesiol & Intens Care Med, D-39106 Magdeburg, Germany
Licker, M:
Univ Hosp Geneva, Fac Med, Dept Anaesthesiol Pharmacol & Intens Care, Geneva, Switzerland
Lin, WQ:
Sun Yat Sen Univ, Ctr Canc, State Key Lab Oncol South China, Guangzhou 510275, Guangdong, Peoples R China
Maslow, AD:
Brown Univ, Dept Anesthesiol, Warren Alpert Sch, Providence, RI 02912 USA
Memtsoudis, SG:
Cornell Univ, Weill Med Coll, Hosp Special Surg, Dept Anesthesiol, New York, NY 10021 USA
Miranda, DR:
Erasmus MC, Dept Intens Care, Rotterdam, Netherlands
Moine, P:
Univ Colorado, Dept Anesthesiol, Aurora, CO USA
Ng, T:
Brown Univ, Dept Surg, Warren Alpert Sch, Providence, RI 02912 USA
Paparella, D:
Univ Bari Aldo Moro, Dept Emergency & Organ Transplant, Div Cardiac Surg, Bari, Italy
Putensen, C:
Univ Bonn, Dept Anesthesiol, Bonn, Germany
Ranieri, M:
Univ Turin, Dipartimento Discipline Med Chirurg, Anestesiol & Rianimaz, Turin, Italy
Scavonetto, F:
Mayo Clin, Coll Med, Dept Anesthesiol, Rochester, MN USA
Mayo Clin, Coll Med, Anesthesia Clin Res Unit, Rochester, MN USA
Schilling, T:
Univ Magdeburg, Dept Anesthesiol & Intens Care Med, D-39106 Magdeburg, Germany
Schmid, W:
Med Univ, Dept Cardiothorac & Vasc Anesthesia & Intens Care, Vienna, Austria
Selmo, G:
Univ Insubria, Dept Environm Hlth & Safety, Varese, Italy
Severgnini, P:
Univ Insubria, Dept Environm Hlth & Safety, Varese, Italy
Sprung, J:
Mayo Clin, Div Pulm & Crit Care Med, Rochester, MN USA
Sundar, S:
Beth Israel Deaconess Med Ctr, Dept Anesthesia Crit Care & Pain Med, Boston, MA 02215 USA
Talmor, D:
Beth Israel Deaconess Med Ctr, Dept Anesthesia Crit Care & Pain Med, Boston, MA 02215 USA
Treschan, T:
Dusseldorf Univ Hosp, Dept Anaesthesiol, Dusseldorf, Germany
Unzueta, C:
Hosp Santa Creu & Sant Pau, Dept Anaesthesiol, Barcelona, Spain
Weingarten, TN:
Mayo Clin, Coll Med, Dept Anesthesiol, Rochester, MN USA
Mayo Clin, Coll Med, Anesthesia Clin Res Unit, Rochester, MN USA
Wolthuis, EK:
Univ Amsterdam, Acad Med Ctr, Dept Intens Care, NL-1105 AZ Amsterdam, Netherlands
Wrigge, H:
Univ Leipzig, Dept Anesthesiol & Intens Care Med, D-04109 Leipzig, Germany
de Abreu, MG:
Tech Univ Dresden, Univ Hosp Carl Gustav Carus, Dept Anesthesiol & Intens Care Med, D-01062 Dresden, Germany
Pelosi, P:
Univ Genoa, IRCCS San Martino IST, Dept Surg Sci & Integrated Diagnost, Genoa, Italy
Schultz, MJ:
Univ Amsterdam, Acad Med Ctr, Dept Intens Care, NL-1105 AZ Amsterdam, Netherlands
Univ Amsterdam, Acad Med Ctr, Lab Expt Intens Care & Anesthesiol, NL-1105 AZ Amsterdam, Netherlands
|