首页 文献索引 SCI期刊 AI助手
登录 注册
首页 正文

Review Anaesthesia. 2025 Mar 25. doi: 10.1111/anae.16600 Q17.52024

Intra-operative ventilation strategies and their impact on clinical outcomes: a systematic review and network meta-analysis of randomised trials

术中通气策略及其对临床结果的影响：随机试验的系统评价和网络Meta分析 翻译改进

Naheed K Jivraj  1  2, Ines Lakbar  3, Behnam Sadeghirad  4  5, Mattia M Müller  6, Sei Yon Sohn  7, John K Peel  8, Arzina Jaffer  9, Vorakamol Phoophiboon  10  11, Vatsal Trivedi  12, Dipayan Chaudhuri  13, Cong Lu  14, Yunting Liu  15, Benedetta Giammarioli  10, Sharon Einav  16, Karen E A Burns  2  11

作者单位 +展开

作者单位

  • 1 Department of Anesthesiology and Pain Medicine and Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
  • 2 Interdepartmental Division of Critical Care Medicine, Temerty School of Medicine, University of Toronto, Toronto, ON, Canada.
  • 3 Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, Montpellier, France.
  • 4 Department of Anesthesia and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
  • 5 Michael DeGroote Institute for Pain Research and Care, Hamilton, ON, Canada.
  • 6 Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
  • 7 Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA.
  • 8 Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
  • 9 Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • 10 Division of Critical Care Medicine, Unity Health Toronto - St. Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada.
  • 11 Division of Critical Care Medicine, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
  • 12 Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.
  • 13 Division of Critical Care, Intensive Care Unit, Department of Medicine, McMaster University, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
  • 14 Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.
  • 15 Department of Laboratory Medicine and Pathobiology, University of Toronto, ON, Canada.
  • 16 Maccabi Healthcare Services Sharon Region, Hebrew University Faculty of Medicine and Medint Medical Intelligence, Jerusalem, Israel.

    • DOI: 10.1111/anae.16600 PMID: 40133080

    摘要 Ai翻译

    Introduction: Postoperative pulmonary complications are common and associated with significant morbidity and mortality; however, the optimal intra-operative ventilation strategy to prevent postoperative pulmonary complications remains unclear. The aim of this study was to evaluate the effect of intra-operative ventilation strategy, including tidal volumes, positive end-expiratory pressure (PEEP) and use of recruitment manoeuvres on the incidence of postoperative pulmonary complications in adults having non-cardiothoracic surgery.

    Methods: Relevant databases were searched to identify randomised controlled trials that directly compared intra-operative ventilation strategies among surgical patients who were followed up for > 24 hours postoperatively and reported at least one outcome of interest.

    Results: A total of 51 randomised controlled trials were included. Compared with a high tidal volume/zero PEEP strategy, low tidal volume strategies likely reduced the risk of postoperative pulmonary complications when combined with: high PEEP (risk ratio (RR) 0.44, 95%CI 0.22-0.87); high PEEP with recruitment manoeuvres (RR 0.60, 95%CI 0.49-0.75); personalised PEEP with recruitment manoeuvres (RR 0.53, 95%CI 0.42-0.69); low PEEP (RR 0.63, 95%CI 0.50-0.78); and low PEEP with recruitment manoeuvres (RR 0.65, 95%CI 0.46-0.93) (all moderate certainty evidence). Compared with a low tidal volume/low PEEP strategy, a low tidal volume strategy with personalised PEEP likely reduces the risk of postoperative pulmonary complications (RR 0.85, 95%CI 0.73-0.99, moderate certainty).

    Discussion: Among patients undergoing non-cardiothoracic surgery, the use of intra-operative low tidal volume ventilation with a range of acceptable PEEP levels likely reduced the risk of postoperative pulmonary complications compared with high tidal volumes and zero PEEP. This study highlights the need for implementation research at both the provider and system levels to improve intra-operative adherence to lung protective ventilation strategies.

    Keywords: intra‐operative; lung protective ventilation; mechanical ventilation; postoperative pulmonary complications.

    Keywords：clinical outcomes; network meta-analysis; randomised trials

    关键词：术中通气策略; 临床结局; 随机试验

    Copyright © Anaesthesia. 中文内容为AI机器翻译，仅供参考！

    相关内容

    期刊名：Anaesthesia

    缩写：ANAESTHESIA

    ISSN：0003-2409

    e-ISSN：1365-2044

    IF/分区：7.5/Q1

    文章目录 更多期刊信息

    全文链接
    官方链接
    PMC全文
    引文链接
    复制
    已复制！
    推荐内容
    Intra-operative ventilation strategies and their impact on clinical outcomes: a systematic review and network meta-analysis of randomised trials