Intraoperative positive end-expiratory pressure and postoperative pulmonary complications: a patient-level meta-analysis of three randomised clinical trials
Issued Date
2022-06-01
Resource Type
ISSN
00070912
eISSN
14716771
Scopus ID
2-s2.0-85128227457
Pubmed ID
35431038
Journal Title
British Journal of Anaesthesia
Volume
128
Issue
6
Start Page
1040
End Page
1051
Rights Holder(s)
SCOPUS
Bibliographic Citation
British Journal of Anaesthesia Vol.128 No.6 (2022) , 1040-1051
Suggested Citation
Campos N.S., Bluth T., Hemmes S.N.T., Librero J., Pozo N., Ferrando C., Ball L., Mazzinari G., Pelosi P., Gama de Abreu M., Schultz M.J., Serpa Neto A. Intraoperative positive end-expiratory pressure and postoperative pulmonary complications: a patient-level meta-analysis of three randomised clinical trials. British Journal of Anaesthesia Vol.128 No.6 (2022) , 1040-1051. 1051. doi:10.1016/j.bja.2022.02.039 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85837
Title
Intraoperative positive end-expiratory pressure and postoperative pulmonary complications: a patient-level meta-analysis of three randomised clinical trials
Author's Affiliation
Navarrabiomed
Universitätsklinikum Carl Gustav Carus Dresden
Melbourne Medical School
IRCCS San Martino Polyclinic Hospital
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias
Hospital Universitari i Politècnic La Fe
Monash University
Hospital Israelita Albert Einstein
Hospital Clinico Universitario de Valencia
Mahidol University
Nuffield Department of Medicine
Universidade de São Paulo
Amsterdam UMC - University of Amsterdam
Universitätsklinikum Carl Gustav Carus Dresden
Melbourne Medical School
IRCCS San Martino Polyclinic Hospital
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias
Hospital Universitari i Politècnic La Fe
Monash University
Hospital Israelita Albert Einstein
Hospital Clinico Universitario de Valencia
Mahidol University
Nuffield Department of Medicine
Universidade de São Paulo
Amsterdam UMC - University of Amsterdam
Other Contributor(s)
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).