Background

The debate on lung-protective ventilation strategies for surgical patients is ongoing. Evidence suggests that the use of low tidal volume V_T improves clinical outcomes. However, the optimal levels of PEEP and recruitment manoeuvre (RM) strategies incorporated into low V_T ventilation remain unclear.

Methods

Several electronic databases were searched to identify RCTs that focused on comparison between low V_T strategy and conventional mechanical ventilation (CMV), or between two different low V_T strategies in surgical patients. The primary outcome was postoperative pulmonary complications (PPCs). The secondary outcomes were atelectasis, pneumonia, acute respiratory distress syndrome, and short-term mortality. Bayesian network meta-analyses were performed using WinBUGS. The odds ratios (ORs) and corresponding 95% credible intervals (CrIs) were estimated.

Results

Compared with CMV, low V_T ventilation with moderate-to-high PEEP reduced the risk of PPCs (moderate PEEP [5–8 cm H₂O]: OR 0.50 [95% CrI: 0.28, 0.89]; moderate PEEP+RMs: 0.39 [0.19, 0.78]; and high PEEP [≥9 cm H₂O]+RMs: 0.34 [0.14, 0.79]). Low V_T ventilation with moderate-to-high PEEP and RMs also specifically reduced the risk of atelectasis compared with CMV (moderate PEEP+RMs: OR 0.36 [95% CrI: 0.16, 0.87]; and high PEEP+RMs: 0.41 [0.15, 0.97]), whilst low V_T ventilation with moderate PEEP was superior to CMV in reducing the risk of pneumonia (OR 0.46 [95% CrI: 0.15, 0.94]).

Conclusions

The combination of low V_T ventilation and moderate-to-high PEEP (≥5 cm H₂O) seems to confer lung protection in surgical patients undergoing general anaesthesia.

Clinical trial registration

PROSPERO (CRD42019144561)

中文翻译：

---

术中通气策略预防术后肺部并发症：随机对照试验的网络荟萃分析

背景

关于外科手术患者的肺保护通气策略的争论仍在进行中。有证据表明，使用低潮气量V _T可改善临床结局。然而，PEEP和招募策略（RM）纳入低V _T通气的最佳水平仍不清楚。

方法

搜索了几个电子数据库以识别RCT，这些RCT专注于比较低V _T策略和常规机械通气（CMV）或手术患者中两种不同的低V _T策略之间的比较。主要结果是术后肺部并发症（PPC）。次要结果是肺不张，肺炎，急性呼吸窘迫综合征和短期死亡率。使用WinBUGS进行贝叶斯网络荟萃分析。估计了优势比（OR）和相应的95％可信区间（CrIs）。

结果

与CMV相比，低V _T通气和中高PEEP降低了PPC的风险（中度PEEP [5-8 cm H ₂ O]：或0.50 [95％CrI：0.28、0.89]；中度PEEP + RMs： 0.39 [0.19，0.78]；高PEEP [≥9cm H ₂ O] + RMs：0.34 [0.14，0.79]。与CMV相比，低V _T通气，中高PEEP和RMs还可以降低肺不张的风险（中度PEEP + RMs：OR 0.36 [95％CrI：0.16，0.87]；高PEEP + RMs：0.41 [0.15] ，0.97]），而在中等PEEP下低V _T通气在降低肺炎风险方面优于CMV（OR 0.46 [95％CrI：0.15，0.94]）。

结论

低V _T通气和中高PEEP（≥5 cm H ₂ O）的结合似乎可为接受全身麻醉的手术患者提供肺保护。

临床试验注册

PROSPERO（CRD42019144561）