Objective

Pulmonary atelectasis is a common postoperative complication that may lead to intrapulmonary shunt, refractory hypoxemia, and respiratory distress. Recruitment maneuvers may relieve pulmonary atelectasis in patients undergoing thoracic surgery. This meta-analysis of randomized controlled trials (RCTs) is to evaluate the effectiveness and safety of recruitment maneuvers in patients undergoing thoracic surgery.

Methods

We performed a literature search on the PubMed, Embase, and Cochrane Library databases and the ClinicalTrials.gov registry for trials published before April 2021. We investigated postoperative pulmonary atelectasis incidence, intrapulmonary shunt fraction, static lung compliance, and mean arterial pressure.

Results

Six RCTs involving 526 patients were reviewed. Patients receiving a recruitment maneuver exhibited a significant decrease in intrapulmonary shunt fraction [weighted mean difference (WMD) − 0.02, 95% CI − 0.03 to − 0.01], improved static lung compliance (WMD 2.16; 95% CI 1.14–3.18), and PaO₂/FIO₂ ratio (WMD 31.31; 95% CI 12.11–50.52) without a significant difference in mean arterial pressure (WMD − 0.64; 95% CI − 4.92 to 3.64). The incidence pulmonary atelectasis favored recruitment maneuver group, but was not statistically significant (RR 0.55; 95% CI 0.27–1.12).

Conclusions

Recruitment maneuvers may be a viable treatment for reducing intra-pulmonary shunt and improving static lung compliance and PaO₂/FIO₂ ratio without the disturbance of hemodynamics in patients undergoing thoracic surgery.

中文翻译：

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胸外科手术患者的肺复张操作：荟萃分析

客观的

肺不张是术后常见的并发症，可导致肺内分流、难治性低氧血症和呼吸窘迫。肺复张操作可以缓解接受胸外科手术的患者的肺不张。这项随机对照试验 (RCT) 的荟萃分析旨在评估复张操作在接受胸外科手术的患者中的有效性和安全性。

方法

我们在 PubMed、Embase 和 Cochrane 图书馆数据库以及 ClinicalTrials.gov 注册中心对 2021 年 4 月之前发表的试验进行了文献检索。我们调查了术后肺不张发生率、肺内分流分数、静态肺顺应性和平均动脉压。

结果

回顾了涉及 526 名患者的六项 RCT。接受复张操作的患者表现出肺内分流分数显着降低 [加权平均差 (WMD) - 0.02，95% CI - 0.03 至 - 0.01]，改善静态肺顺应性（WMD 2.16；95% CI 1.14-3.18），以及PaO ₂ /FIO ₂比值（WMD 31.31；95% CI 12.11–50.52），平均动脉压没有显着差异（WMD − 0.64；95% CI − 4.92 到 3.64）。肺不张的发生率有利于复张操作组，但无统计学意义（RR 0.55；95% CI 0.27-1.12）。

结论

肺复张操作可能是减少肺内分流和改善静态肺顺应性和 PaO ₂ /FIO ₂比值的可行治疗方法，而不会干扰接受胸外科手术的患者的血流动力学。