Protective versus Conventional Ventilation for Surgery A Systematic Review and Individual Patient Data Meta-analysis

Ary Serpa Neto; Sabrine N. T. Hemmes; Carmen S. V. Barbas; Martin Beiderlinden; Michelle Biehl; Jan M. Binnekade; Jaume Canet; Ana Fernandez-Bustamante; Emmanuel Futier; Ognjen Gajic; Göran Hedenstierna; Markus W. Hollmann; Samir Jaber; Alf Kozian; Marc Licker; Wen-Qian Lin; Andrew D. Maslow; Stavros G. Memtsoudis; Dinis Reis Miranda; Pierre Moine; Thomas Ng; Domenico Paparella; Christian Putensen; Marco Ranieri; Federica Scavonetto; Thomas Schilling; Werner Schmid; Gabriele Selmo; Paolo Severgnini; Juraj Sprung; Sugantha Sundar; Daniel Talmor; Tanja Treschan; Carmen Unzueta; Toby N. Weingarten; Esther K. Wolthuis; Hermann Wrigge; Marcelo Gama de Abreu; Paolo Pelosi; Marcus J. Schultz

doi:https://doi.org/10.1097/ALN.0000000000000706

Protective versus Conventional Ventilation for Surgery A Systematic Review and Individual Patient Data Meta-analysis

Ary Serpa Neto, Sabrine N. T. Hemmes, Carmen S. V. Barbas, Martin Beiderlinden, Michelle Biehl, Jan M. Binnekade, Jaume Canet, Ana Fernandez-Bustamante, Emmanuel Futier, Ognjen Gajic, Göran Hedenstierna, Markus W. Hollmann, Samir Jaber, Alf Kozian, Marc Licker, Wen-Qian Lin, Andrew D. Maslow, Stavros G. Memtsoudis, Dinis Reis Miranda, Pierre MoineThomas Ng, Domenico Paparella, Christian Putensen, Marco Ranieri, Federica Scavonetto, Thomas Schilling, Werner Schmid, Gabriele Selmo, Paolo Severgnini, Juraj Sprung, Sugantha Sundar, Daniel Talmor, Tanja Treschan, Carmen Unzueta, Toby N. Weingarten, Esther K. Wolthuis, Hermann Wrigge, Marcelo Gama de Abreu, Paolo Pelosi, Marcus J. Schultz

Research output: Contribution to journal › Article › Academic › peer-review

270 Citations (Scopus)

Abstract

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

Original language	English
Pages (from-to)	66-78
Journal	Anesthesiology
Volume	123
Issue number	1
DOIs	https://doi.org/10.1097/ALN.0000000000000706
Publication status	Published - 2015

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Serpa Neto, A., Hemmes, S. N. T., Barbas, C. S. V., Beiderlinden, M., Biehl, M., Binnekade, J. M., Canet, J., Fernandez-Bustamante, A., Futier, E., Gajic, O., Hedenstierna, G., Hollmann, M. W., Jaber, S., Kozian, A., Licker, M., Lin, W.-Q., Maslow, A. D., Memtsoudis, S. G., Reis Miranda, D., ... Schultz, M. J. (2015). Protective versus Conventional Ventilation for Surgery A Systematic Review and Individual Patient Data Meta-analysis. Anesthesiology, 123(1), 66-78. https://doi.org/10.1097/ALN.0000000000000706

@article{07d326280c3f491887da29f61b6b79d5,

title = "Protective versus Conventional Ventilation for Surgery A Systematic Review and Individual Patient Data Meta-analysis",

abstract = "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",

author = "{Serpa Neto}, Ary and Hemmes, {Sabrine N. T.} and Barbas, {Carmen S. V.} and Martin Beiderlinden and Michelle Biehl and Binnekade, {Jan M.} and Jaume Canet and Ana Fernandez-Bustamante and Emmanuel Futier and Ognjen Gajic and G{\"o}ran Hedenstierna and Hollmann, {Markus W.} and Samir Jaber and Alf Kozian and Marc Licker and Wen-Qian Lin and Maslow, {Andrew D.} and Memtsoudis, {Stavros G.} and {Reis Miranda}, Dinis and Pierre Moine and Thomas Ng and Domenico Paparella and Christian Putensen and Marco Ranieri and Federica Scavonetto and Thomas Schilling and Werner Schmid and Gabriele Selmo and Paolo Severgnini and Juraj Sprung and Sugantha Sundar and Daniel Talmor and Tanja Treschan and Carmen Unzueta and Weingarten, {Toby N.} and Wolthuis, {Esther K.} and Hermann Wrigge and {Gama de Abreu}, Marcelo and Paolo Pelosi and Schultz, {Marcus J.}",

year = "2015",

doi = "https://doi.org/10.1097/ALN.0000000000000706",

language = "English",

volume = "123",

pages = "66--78",

journal = "Anesthesiology",

issn = "0003-3022",

publisher = "Lippincott Williams and Wilkins",

number = "1",

}

Serpa Neto, A, 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, W-Q, Maslow, AD, Memtsoudis, SG, Reis Miranda, D, 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, Gama de Abreu, M, Pelosi, P & Schultz, MJ 2015, 'Protective versus Conventional Ventilation for Surgery A Systematic Review and Individual Patient Data Meta-analysis', Anesthesiology, vol. 123, no. 1, pp. 66-78. https://doi.org/10.1097/ALN.0000000000000706

TY - JOUR

T1 - Protective versus Conventional Ventilation for Surgery A Systematic Review and Individual Patient Data Meta-analysis

AU - Serpa Neto, Ary

AU - Hemmes, Sabrine N. T.

AU - Barbas, Carmen S. V.

AU - Beiderlinden, Martin

AU - Biehl, Michelle

AU - Binnekade, Jan M.

AU - Canet, Jaume

AU - Fernandez-Bustamante, Ana

AU - Futier, Emmanuel

AU - Gajic, Ognjen

AU - Hedenstierna, Göran

AU - Hollmann, Markus W.

AU - Jaber, Samir

AU - Kozian, Alf

AU - Licker, Marc

AU - Lin, Wen-Qian

AU - Maslow, Andrew D.

AU - Memtsoudis, Stavros G.

AU - Reis Miranda, Dinis

AU - Moine, Pierre

AU - Ng, Thomas

AU - Paparella, Domenico

AU - Putensen, Christian

AU - Ranieri, Marco

AU - Scavonetto, Federica

AU - Schilling, Thomas

AU - Schmid, Werner

AU - Selmo, Gabriele

AU - Severgnini, Paolo

AU - Sprung, Juraj

AU - Sundar, Sugantha

AU - Talmor, Daniel

AU - Treschan, Tanja

AU - Unzueta, Carmen

AU - Weingarten, Toby N.

AU - Wolthuis, Esther K.

AU - Wrigge, Hermann

AU - Gama de Abreu, Marcelo

AU - Pelosi, Paolo

AU - Schultz, Marcus J.

PY - 2015

Y1 - 2015

N2 - 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

AB - 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

U2 - https://doi.org/10.1097/ALN.0000000000000706

DO - https://doi.org/10.1097/ALN.0000000000000706

M3 - Article

C2 - 25978326

SN - 0003-3022

VL - 123

SP - 66

EP - 78

JO - Anesthesiology

JF - Anesthesiology

IS - 1

ER -