High PEEP with recruitment maneuvers versus Low PEEP During General Anesthesia for Surgery -a Bayesian individual patient data meta-analysis of three randomized clinical trials
1
Issued Date
2024-01-01
Resource Type
ISSN
00033022
eISSN
15281175
Scopus ID
2-s2.0-85200469186
Journal Title
Anesthesiology
Rights Holder(s)
SCOPUS
Bibliographic Citation
Anesthesiology (2024)
Suggested Citation
Mazzinari G., Zampieri F.G., Ball L., Campos N.S., Bluth T., Hemmes S.N.T., Ferrando C., Librero J., Soro M., Pelosi P., de Abreu M.G., Schultz M.J., Neto A.S., Campos N.S., Bluth T., Hemmes S.N.T., de Abreu M.G., Schultz M.J., Neto A.S., Campos N.S., Bluth T., Hemmes S.N.T., Librero J., Pozo N., Ferrando C., Ball L., Mazzinari G., de Abreu M.G., Schultz M.J., Neto A.S., Hemmes S.N.T., de Abreu M.G., Severgnini P., Hollmann M.W., Binnekade J.M., Wrigge H., Canet J., Hiesmayr M., Schmid W., Tschernko E., Jaber S., Hedenstierna G., Putensen C., Schultz M.J., Marti A., Bacuzzi A., Brodhun A., Molin A., Merten A., Parera A., Brunelli A., Cortegiani A., Güldner A., Reske A.W., Gratarola A., Giarratano A., Bastin B., Heyse B., Mazul-Sunko B., Amantea B., Barberis B., Putensen C., Uhlig C., Marín C.M., Celentano C., La Bella D., D'Antini D., Velghe D., Sulemanji D., De Robertis E., Hartmann E., Montalto F., Tropea F., Mills G.H., Cinnella G., Della Rocca G., Caggianelli G., Pellerano G., Mollica G., Bugedo G., Wrigge H., Mulier J.P., Vandenbrande J., Geib J., Yaqub J., Florez J., Mayoral J.F., Sprung J., Van Limmen J., Bos L.D.J., de Baerdemaeker L., Jamaer L., Spagnolo L., Strys L., Gil M.G., de Abreu M.G., Vidal Melo M.F., Schultz M.J., Unzueta M.C., Moral M.V. High PEEP with recruitment maneuvers versus Low PEEP During General Anesthesia for Surgery -a Bayesian individual patient data meta-analysis of three randomized clinical trials. Anesthesiology (2024). doi:10.1097/ALN.0000000000005170 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/100464
Title
High PEEP with recruitment maneuvers versus Low PEEP During General Anesthesia for Surgery -a Bayesian individual patient data meta-analysis of three randomized clinical trials
Author(s)
Mazzinari G.
Zampieri F.G.
Ball L.
Campos N.S.
Bluth T.
Hemmes S.N.T.
Ferrando C.
Librero J.
Soro M.
Pelosi P.
de Abreu M.G.
Schultz M.J.
Neto A.S.
Campos N.S.
Bluth T.
Hemmes S.N.T.
de Abreu M.G.
Schultz M.J.
Neto A.S.
Campos N.S.
Bluth T.
Hemmes S.N.T.
Librero J.
Pozo N.
Ferrando C.
Ball L.
Mazzinari G.
de Abreu M.G.
Schultz M.J.
Neto A.S.
Hemmes S.N.T.
de Abreu M.G.
Severgnini P.
Hollmann M.W.
Binnekade J.M.
Wrigge H.
Canet J.
Hiesmayr M.
Schmid W.
Tschernko E.
Jaber S.
Hedenstierna G.
Putensen C.
Schultz M.J.
Marti A.
Bacuzzi A.
Brodhun A.
Molin A.
Merten A.
Parera A.
Brunelli A.
Cortegiani A.
Güldner A.
Reske A.W.
Gratarola A.
Giarratano A.
Bastin B.
Heyse B.
Mazul-Sunko B.
Amantea B.
Barberis B.
Putensen C.
Uhlig C.
Marín C.M.
Celentano C.
La Bella D.
D'Antini D.
Velghe D.
Sulemanji D.
De Robertis E.
Hartmann E.
Montalto F.
Tropea F.
Mills G.H.
Cinnella G.
Della Rocca G.
Caggianelli G.
Pellerano G.
Mollica G.
Bugedo G.
Wrigge H.
Mulier J.P.
Vandenbrande J.
Geib J.
Yaqub J.
Florez J.
Mayoral J.F.
Sprung J.
Van Limmen J.
Bos L.D.J.
de Baerdemaeker L.
Jamaer L.
Spagnolo L.
Strys L.
Gil M.G.
de Abreu M.G.
Vidal Melo M.F.
Schultz M.J.
Unzueta M.C.
Moral M.V.
Zampieri F.G.
Ball L.
Campos N.S.
Bluth T.
Hemmes S.N.T.
Ferrando C.
Librero J.
Soro M.
Pelosi P.
de Abreu M.G.
Schultz M.J.
Neto A.S.
Campos N.S.
Bluth T.
Hemmes S.N.T.
de Abreu M.G.
Schultz M.J.
Neto A.S.
Campos N.S.
Bluth T.
Hemmes S.N.T.
Librero J.
Pozo N.
Ferrando C.
Ball L.
Mazzinari G.
de Abreu M.G.
Schultz M.J.
Neto A.S.
Hemmes S.N.T.
de Abreu M.G.
Severgnini P.
Hollmann M.W.
Binnekade J.M.
Wrigge H.
Canet J.
Hiesmayr M.
Schmid W.
Tschernko E.
Jaber S.
Hedenstierna G.
Putensen C.
Schultz M.J.
Marti A.
Bacuzzi A.
Brodhun A.
Molin A.
Merten A.
Parera A.
Brunelli A.
Cortegiani A.
Güldner A.
Reske A.W.
Gratarola A.
Giarratano A.
Bastin B.
Heyse B.
Mazul-Sunko B.
Amantea B.
Barberis B.
Putensen C.
Uhlig C.
Marín C.M.
Celentano C.
La Bella D.
D'Antini D.
Velghe D.
Sulemanji D.
De Robertis E.
Hartmann E.
Montalto F.
Tropea F.
Mills G.H.
Cinnella G.
Della Rocca G.
Caggianelli G.
Pellerano G.
Mollica G.
Bugedo G.
Wrigge H.
Mulier J.P.
Vandenbrande J.
Geib J.
Yaqub J.
Florez J.
Mayoral J.F.
Sprung J.
Van Limmen J.
Bos L.D.J.
de Baerdemaeker L.
Jamaer L.
Spagnolo L.
Strys L.
Gil M.G.
de Abreu M.G.
Vidal Melo M.F.
Schultz M.J.
Unzueta M.C.
Moral M.V.
Author's Affiliation
Instituto de Investigación Sanitaria Fundación Para la Investigación del Hospital Clínico de Valencia - INCLIVA
Navarrabiomed
Universitätsklinikum Carl Gustav Carus Dresden
Mahidol Oxford Tropical Medicine Research Unit
Melbourne Medical School
IRCCS San Martino Polyclinic Hospital
Instituto de Investigación Sanitaria La Fe
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias
General Hospital St. Jan
Università degli studi Magna Graecia di Catanzaro
Universitair Ziekenhuis Gent
Hospital Universitari i Politècnic La Fe
Johannes Gutenberg-Universität Mainz
Universitätsklinikum Bonn
Hospital Clínic de Barcelona
Massachusetts General Hospital
Pontificia Universidad Católica de Chile
Hospital Universitari Germans Trias i Pujol
Hôpital Saint Eloi
Università degli Studi di Udine
Heinrich-Heine-Universität Düsseldorf
Università degli Studi di Genova
Sheffield Teaching Hospitals NHS Foundation Trust
Università degli Studi di Foggia
Cleveland Clinic Foundation
Monash University
University of Alberta, Faculty of Medicine and Dentistry
Università degli Studi di Palermo
Università degli Studi di Napoli Federico II
Hospital Israelita Albert Einstein
Fundacio Puigvert
Hospital Clinico Universitario de Valencia
Medizinische Universität Wien
Hospital de La Santa Creu I Sant Pau
ZiekenhuisNetwerk Antwerpen
Universidade de São Paulo
Universität Leipzig
Mayo Clinic
Università degli Studi dell'Insubria
Uppsala Universitet
Universitat de València
Universiteit van Amsterdam
Amsterdam UMC - University of Amsterdam
Azienda Sanitaria Locale TO3 - Ospedale di Rivoli
PROtective VEntilation Network
University Hospital Sveti Duh
Hospital de Manises
Virga Jesse Ziekenhuis
Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A)
General Universitario
Navarrabiomed
Universitätsklinikum Carl Gustav Carus Dresden
Mahidol Oxford Tropical Medicine Research Unit
Melbourne Medical School
IRCCS San Martino Polyclinic Hospital
Instituto de Investigación Sanitaria La Fe
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias
General Hospital St. Jan
Università degli studi Magna Graecia di Catanzaro
Universitair Ziekenhuis Gent
Hospital Universitari i Politècnic La Fe
Johannes Gutenberg-Universität Mainz
Universitätsklinikum Bonn
Hospital Clínic de Barcelona
Massachusetts General Hospital
Pontificia Universidad Católica de Chile
Hospital Universitari Germans Trias i Pujol
Hôpital Saint Eloi
Università degli Studi di Udine
Heinrich-Heine-Universität Düsseldorf
Università degli Studi di Genova
Sheffield Teaching Hospitals NHS Foundation Trust
Università degli Studi di Foggia
Cleveland Clinic Foundation
Monash University
University of Alberta, Faculty of Medicine and Dentistry
Università degli Studi di Palermo
Università degli Studi di Napoli Federico II
Hospital Israelita Albert Einstein
Fundacio Puigvert
Hospital Clinico Universitario de Valencia
Medizinische Universität Wien
Hospital de La Santa Creu I Sant Pau
ZiekenhuisNetwerk Antwerpen
Universidade de São Paulo
Universität Leipzig
Mayo Clinic
Università degli Studi dell'Insubria
Uppsala Universitet
Universitat de València
Universiteit van Amsterdam
Amsterdam UMC - University of Amsterdam
Azienda Sanitaria Locale TO3 - Ospedale di Rivoli
PROtective VEntilation Network
University Hospital Sveti Duh
Hospital de Manises
Virga Jesse Ziekenhuis
Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A)
General Universitario
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: The influence of high positive end-expiratory pressure (PEEP) with recruitment maneuvers on the occurrence of postoperative pulmonary complications after surgery is still not definitively established. Bayesian analysis can help to gain further insights from the available data and provide a probabilistic framework that is easier to interpret. Our objective was to estimate the posterior probability that the use of high PEEP with recruitment maneuvers is associated with reduced postoperative pulmonary complications in patients with intermediate-to-high risk under neutral, pessimistic, and optimistic expectations regarding the treatment effect. Methods: Multilevel Bayesian logistic regression analysis on individual patient data from three randomized clinical trials carried out on surgical patients at Intermediate-to-High Risk for postoperative pulmonary complications. The main outcome was the occurrence of postoperative pulmonary complications in the early postoperative period. We studied the effect of high PEEP with recruitment maneuvers versus Low PEEP Ventilation. Priors were chosen to reflect neutral, pessimistic, and optimistic expectations of the treatment effect. Results: Using a neutral, pessimistic, or optimistic prior, the posterior mean odds ratio (OR) for High PEEP with recruitment maneuvers compared to Low PEEP was 0.85 (95% Credible Interval [CrI] 0.71 to 1.02), 0.87 (0.72 to 1.04), and 0.86 (0.71 to 1.02), respectively. Regardless of prior beliefs, the posterior probability of experiencing a beneficial effect exceeded 90%. Subgroup analysis indicated a more pronounced effect in patients who underwent laparoscopy (OR: 0.67 [0.50 to 0.87]) and those at high risk for PPCs (OR: 0.80 [0.53 to 1.13]). Sensitivity analysis, considering severe postoperative pulmonary complications only or applying a different heterogeneity prior, yielded consistent results. Conclusion: High PEEP with recruitment maneuvers demonstrated a moderate reduction in the probability of PPC occurrence, with a high posterior probability of benefit observed consistently across various prior beliefs, particularly among patients who underwent laparoscopy.