BACKGROUND Obesity is a global epidemic, and it is widely known that increased Body mass index (BMI) is associated with alterations in respiratory mechanics. Bariatric surgery is established as an effective treatment for this condition. OBJECTIVE To assess the safety and effectiveness of different ventilation strategies in obese patients undergoing bariatric surgery. METHODS A systematic review of randomized clinical trials aimed at evaluating ventilation strategies for obese patients was carried out. Primary outcomes: in-hospital mortality, adequacy of gas exchange, and respiration mechanics alterations. RESULTS Fourteen clinical trials with 574 participants were included. When recruitment maneuvers (RM) vs Positive end-expiratory pressure (PEEP) were compared, RM resulted in better oxygenation p = 0.03 (MD 79.93), higher plateau pressure p < 0.00001 (MD 7.30), higher mean airway pressure p < 0.00001 (MD 6.61), and higher compliance p < 0.00001 (MD 21.00); when comparing RM + Zero end-expiratory pressure (ZEEP) vs RM + PEEP 5 or 10 cmH2O, RM associated with PEEP led to better oxygenation p = 0.001 (MD 167.00); when comparing Continuous Positive Airway Pressure (CPAP) 40 cmH2O + PEEP 10 cmH2O vs CPAP 40 cmH2O + PEEP 15 cmH2O, CPAP 40 + PEEP 15 achieved better gas exchange p = 0.003 (MD 36.00) and compliance p = 0.0003 (MD 3.00). CONCLUSION There is some evidence that the alveolar recruitment maneuvers associated with PEEP lead to better oxygenation and higher compliance. There is no evidence of differences between pressure control ventilation (PCV) and Volume control ventilation (VCV).

中文翻译：

---

肥胖患者进行减肥手术的术中通气策略：系统评价和荟萃分析。

背景技术肥胖症是一种全球流行病，众所周知，体重指数（BMI）的增加与呼吸力学的改变有关。减肥手术已被确立为对此病的有效治疗方法。目的评估肥胖手术患者肥胖的不同通气策略的安全性和有效性。方法对旨在评估肥胖患者通气策略的随机临床试验进行了系统评价。主要结果：院内死亡率，气体交换充分和呼吸力学改变。结果包括574名参与者的14项临床试验。当比较招募策略（RM）与呼气末正压（PEEP）时，RM会导致更好的充氧p = 0.03（MD 79.93），较高的高原压力p <0.00001（MD 7.30），较高的平均气道压力p <0.00001（MD 6.61）和较高的顺应性p <0.00001（MD 21.00）; 当比较RM +零呼气末压（ZEEP）与RM + PEEP 5或10 cmH2O时，与PEEP相关的RM导致更好的充氧p = 0.001（MD 167.00）；比较持续气道正压（CPAP）40 cmH2O + PEEP 10 cmH2O和CPAP 40 cmH2O + PEEP 15 cmH2O时，CPAP 40 + PEEP 15的气体交换更好，p = 0.003（MD 36.00），顺应性p = 0.0003（MD 3.00）。结论有证据表明，与PEEP相关的肺泡补充动作可导致更好的充氧和更高的依从性。没有证据表明压力控制通气（PCV）和体积控制通气（VCV）之间存在差异。00001（MD 6.61）和更高的顺从性p <0.00001（MD 21.00）; 当比较RM +零呼气末压（ZEEP）与RM + PEEP 5或10 cmH2O时，与PEEP相关的RM导致更好的充氧p = 0.001（MD 167.00）；比较持续气道正压（CPAP）40 cmH2O + PEEP 10 cmH2O和CPAP 40 cmH2O + PEEP 15 cmH2O时，CPAP 40 + PEEP 15的气体交换更好，p = 0.003（MD 36.00），顺应性p = 0.0003（MD 3.00）。结论有证据表明，与PEEP相关的肺泡补充动作可导致更好的充氧和更高的依从性。没有证据表明压力控制通气（PCV）和体积控制通气（VCV）之间存在差异。00001（MD 6.61）和更高的顺从性p <0.00001（MD 21.00）; 当比较RM +零呼气末压（ZEEP）与RM + PEEP 5或10 cmH2O时，与PEEP相关的RM导致更好的充氧p = 0.001（MD 167.00）；比较持续气道正压（CPAP）40 cmH2O + PEEP 10 cmH2O和CPAP 40 cmH2O + PEEP 15 cmH2O时，CPAP 40 + PEEP 15的气体交换更好，p = 0.003（MD 36.00），顺应性p = 0.0003（MD 3.00）。结论有证据表明，与PEEP相关的肺泡补充动作可导致更好的充氧和更高的依从性。没有证据表明压力控制通气（PCV）和体积控制通气（VCV）之间存在差异。与PEEP相关的RM导致更好的氧合p = 0.001（MD 167.00）; 比较持续气道正压（CPAP）40 cmH2O + PEEP 10 cmH2O和CPAP 40 cmH2O + PEEP 15 cmH2O时，CPAP 40 + PEEP 15的气体交换更好，p = 0.003（MD 36.00），顺应性p = 0.0003（MD 3.00）。结论有证据表明，与PEEP相关的肺泡补充动作可导致更好的充氧和更高的依从性。没有证据表明压力控制通气（PCV）和体积控制通气（VCV）之间存在差异。与PEEP相关的RM导致更好的氧合p = 0.001（MD 167.00）; 比较持续气道正压（CPAP）40 cmH2O + PEEP 10 cmH2O和CPAP 40 cmH2O + PEEP 15 cmH2O时，CPAP 40 + PEEP 15的气体交换更好，p = 0.003（MD 36.00），顺应性p = 0.0003（MD 3.00）。结论有证据表明，与PEEP相关的肺泡补充动作可导致更好的充氧和更高的依从性。没有证据表明压力控制通气（PCV）和体积控制通气（VCV）之间存在差异。结论有证据表明，与PEEP相关的肺泡补充动作可导致更好的充氧和更高的依从性。没有证据表明压力控制通气（PCV）和体积控制通气（VCV）之间存在差异。结论有证据表明，与PEEP相关的肺泡补充动作可导致更好的充氧和更高的依从性。没有证据表明压力控制通气（PCV）和体积控制通气（VCV）之间存在差异。