Intraoperative positive end-expiratory pressure and postoperative pulmonary complications: a patient-level meta-analysis of three randomised clinical trials.

Fecha de publicación: 01/01/2022 Fecha Ahead of Print: 15/04/2022

Autores de IIS La Fe

Guido Mazzinari

Autor

Participantes ajenos a IIS La Fe

Campos NS
Bluth T
Hemmes, Sabrine N T
Librero J
Pozo N
Ferrando C
Ball L
Pelosi P
Gama de Abreu M
Schultz MJ
Serpa Neto A
REPEAT
investigators for the PROVHILO study
iPROVE study
PROBESE study investigators
PROVE Network

Grupos

Medicina Perioperatoria, Anestesiología y Reanimación

Leader

Óscar Díaz Cambronero

Abstract

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).

Datos de la publicación

ISSN/ISSNe:: 0007-0912, 1471-6771
Tipo:: Article
Páginas:: 1040-1051
DOI:: 10.1016/j.bja.2022.02.039
Factor de Impacto:: 2,642 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Métricas

Filiaciones

Campos NS:: Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil

Cardio-Pulmonary Department, Pulmonary Division, Faculdade de Medicina, Instituto do Coração, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
Bluth T:: Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
Librero J:: Navarrabiomed-Fundación Miguel Servet, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain
Pozo N:: INCLIVA Clinical Research Institute, Hospital Clinico Universitario de Valencia, Valencia, Spain
Ferrando C:: Department of Anesthesiology & Critical Care, Hospital Clinico Universitario de Valencia, Valencia, Spain

CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
Ball L:: Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinico Hospital - IRCCS for Oncology, University of Genoa, Genoa, Italy
Mazzinari G:: Research Group in Perioperative Medicine, Hospital Universitario y Politecnico la Fe, Valencia, Spain

Department of Anesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
Pelosi P:: Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinico Hospital - IRCCS for Oncology, University of Genoa, Genoa, Italy
Gama de Abreu M:: Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
Schultz MJ:: Nuffield Department of Medicine, University of Oxford, Oxford, UK

Mahidol Oxford Research Unit (MORU), Mahidol University, Bangkok, Thailand
Serpa Neto A:: Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil

Cardio-Pulmonary Department, Pulmonary Division, Faculdade de Medicina, Instituto do Coração, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil

Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia

Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia