Intraoperative individualization of positive-end-expiratory pressure through electrical impedance tomography or esophageal pressure assessment: a systematic review and meta-analysis of randomized controlled trials
3
Issued Date
2023-01-01
Resource Type
ISSN
13871307
eISSN
15732614
Scopus ID
2-s2.0-85174727963
Pubmed ID
37863862
Journal Title
Journal of Clinical Monitoring and Computing
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Clinical Monitoring and Computing (2023)
Suggested Citation
Esposito T., Fregonese M., Morettini G., Carboni P., Tardioli C., Messina A., Vaschetto R., Della Corte F., Vetrugno L., Navalesi P., De Robertis E., Azzolina D., Piriyapatsom A., Tucci M.R., Wrigge H., Simon P., Bignami E., Maggiore S.M., Simonte R., Cammarota G. Intraoperative individualization of positive-end-expiratory pressure through electrical impedance tomography or esophageal pressure assessment: a systematic review and meta-analysis of randomized controlled trials. Journal of Clinical Monitoring and Computing (2023). doi:10.1007/s10877-023-01094-2 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/90871
Title
Intraoperative individualization of positive-end-expiratory pressure through electrical impedance tomography or esophageal pressure assessment: a systematic review and meta-analysis of randomized controlled trials
Author's Affiliation
Siriraj Hospital
Azienda Ospedaliera Maggiore della Carita di Novara
Humanitas Research Hospital
University of Ferrara
Universitätsklinikum Halle und Medizinische Fakultät
Universität Augsburg
Universidade de São Paulo
Universität Leipzig
BG-Kliniken Bergmannstrost Halle
Università di Parma
Università degli Studi del Piemonte Orientale "Amedeo Avogadro"
Università degli Studi di Perugia
Università degli Studi di Padova
Università Gabriele D’Annunzio di Chieti-Pescara
Azienda Ospedaliera Maggiore della Carita di Novara
Humanitas Research Hospital
University of Ferrara
Universitätsklinikum Halle und Medizinische Fakultät
Universität Augsburg
Universidade de São Paulo
Universität Leipzig
BG-Kliniken Bergmannstrost Halle
Università di Parma
Università degli Studi del Piemonte Orientale "Amedeo Avogadro"
Università degli Studi di Perugia
Università degli Studi di Padova
Università Gabriele D’Annunzio di Chieti-Pescara
Other Contributor(s)
Abstract
Purpose: This systematic review of randomized-controlled trials (RCTs) with meta-analyses aimed to compare the effects on intraoperative arterial oxygen tension to inspired oxygen fraction ratio (PaO2/FiO2), exerted by positive end-expiratory pressure (PEEP) individualized trough electrical impedance tomography (EIT) or esophageal pressure (Pes) assessment (intervention) vs. PEEP not tailored on EIT or Pes (control), in patients undergoing abdominal or pelvic surgery with an open or laparoscopic/robotic approach. Methods: PUBMED®, EMBASE®, and Cochrane Controlled Clinical trials register were searched for observational studies and RCTs from inception to the end of August 2022. Inclusion criteria were: RCTs comparing PEEP titrated on EIT/Pes assessment vs. PEEP not individualized on EIT/Pes and reporting intraoperative PaO2/FiO2. Two authors independently extracted data from the enrolled investigations. Data are reported as mean difference and 95% confidence interval (CI). Results: Six RCTs were included for a total of 240 patients undergoing general anesthesia for surgery, of whom 117 subjects in the intervention group and 123 subjects in the control group. The intraoperative mean PaO2/FiO2 was 69.6 (95%CI 32.-106.4) mmHg higher in the intervention group as compared with the control group with 81.4% between-study heterogeneity (p < 0.01). However, at meta-regression, the between-study heterogeneity diminished to 44.96% when data were moderated for body mass index (estimate 3.45, 95%CI 0.78–6.11, p = 0.011). Conclusions: In patients undergoing abdominal or pelvic surgery with an open or laparoscopic/robotic approach, PEEP personalized by EIT or Pes allowed the achievement of a better intraoperative oxygenation compared to PEEP not individualized through EIT or Pes. Prospero registration number: CRD 42021218306, 30/01/2023.