TY - JOUR
T1 - Intraoperative positive end-expiratory pressure and postoperative pulmonary complications
T2 - a patient-level meta-analysis of three randomised clinical trials
AU - Campos, Niklas S.
AU - Bluth, Thomas
AU - Hemmes, Sabrine N. T.
AU - Librero, Julian
AU - Pozo, Natividad
AU - Ferrando, Carlos
AU - Ball, Lorenzo
AU - Mazzinari, Guido
AU - Pelosi, Paolo
AU - Gama de Abreu, Marcelo
AU - REPEAT
AU - investigators for the PROVHILO study
AU - the iPROVE study
AU - Schultz, Marcus J.
AU - the PROBESE study investigators
AU - the PROVE Network
AU - Serpa Neto, A.
N1 - Funding Information: REPEAT (an investigator-initiated study) was funded by Hospital Israelita Albert Einstein . The PROVHILO trial (a collaboration of the Protective Ventilation Network [PROVENet]) was funded by the European Society of Anaesthesiology (ESA) and the Academical Medical Center (AMC, Amsterdam, The Netherlands). The iPROVE trial was funded by the Instituto de Salud Carlos III of the Spanish Ministry of Economy and Competitiveness (grant PI14/00829 , co-financed by the European Regional Development Fund), and the Grants Programme of the European Society of Anaesthesiology. The Clinical Trials Network of the European Society of Anaesthesiology provided financial support for the steering committee meetings, onsite visits to participating sites, for the building of the electronic data capture system, and for the advertising of the PROBESE trial. The Technische Universität Dresden provided logistical support for the coordinating site. The Conselho Nacional de Desenvolvimento Científico e Tecnológico provided financial support for insurance in Brazil. The Association of Anaesthetists of Great Britain and Ireland and the Northern Ireland Society of Anaesthetists provided financial support for the participating sites in the UK. Funding Information: REPEAT (an investigator-initiated study) was funded by Hospital Israelita Albert Einstein. The PROVHILO trial (a collaboration of the Protective Ventilation Network [PROVENet]) was funded by the European Society of Anaesthesiology (ESA) and the Academical Medical Center (AMC, Amsterdam, The Netherlands). The iPROVE trial was funded by the Instituto de Salud Carlos III of the Spanish Ministry of Economy and Competitiveness (grant PI14/00829, co-financed by the European Regional Development Fund), and the Grants Programme of the European Society of Anaesthesiology. The Clinical Trials Network of the European Society of Anaesthesiology provided financial support for the steering committee meetings, onsite visits to participating sites, for the building of the electronic data capture system, and for the advertising of the PROBESE trial. The Technische Universität Dresden provided logistical support for the coordinating site. The Conselho Nacional de Desenvolvimento Científico e Tecnológico provided financial support for insurance in Brazil. The Association of Anaesthetists of Great Britain and Ireland and the Northern Ireland Society of Anaesthetists provided financial support for the participating sites in the UK. Publisher Copyright: © 2022 British Journal of Anaesthesia
PY - 2022/6
Y1 - 2022/6
N2 - 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).
AB - 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).
KW - PEEP
KW - mechanical ventilation
KW - postoperative pulmonary complications
KW - surgery
UR - http://www.scopus.com/inward/record.url?scp=85128227457&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.bja.2022.02.039
DO - https://doi.org/10.1016/j.bja.2022.02.039
M3 - Article
C2 - 35431038
SN - 0007-0912
VL - 128
SP - 1040
EP - 1051
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 6
ER -