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

医学围手术期置信区间优势比机械通风随机对照试验麻醉呼气末正压子群分析荟萃分析临床试验外科内科学

作者

Niklas Söderberg Campos,Thomas Bluth,Sabrine N.T. Hemmes,Julián Librero,Natividad Pozo,Carlos Ferrando,Lorenzo Ball,Guido Mazzinari,Paolo Pelosi,Marcelo Gama de Abreu,Marcus J. Schultz,Ary Serpa Neto,Sabrine N.T. Hemmes,Marcelo Gama de Abreu,Paolo Severgnini,Markus W. Hollmann,Jan M. Binnekade,Hermann Wrigge,Jaume Canet,M. Hiesmayr,W. Schmid,Edda Tschernko,Samir Jaber,Göran Hedenstierna,Christian Putensen,Paolo Pelosi,Marcus J. Schultz,Aina Martí,Alessandro Bacuzzi,Alexander Brodhun,Alexandre Molin,Alfred Merten,Ana Parera,Andrea Brunelli,Andrea Cortegiani,Andreas Güldner,Andreas W. Reske,Angelo Gratarola,Antonino Giarratano,Bea Bastin,Björn Heyse,Branka Mazul-Sunko,B Amantea,Bruno Barberis,Christian Putensen,Christopher Uhlig,Cristian Giovanny Gómez Marín,C. Celentano,Daniela La Bella,David D’Antini,David Velghe,Demet Sulemanji,Edoardo De Robertis,Erik K. Hartmann,Francesca Montalto,Francesco Tropea,Gary Mills,Gilda Cinnella,Giorgio Della Rocca,Girolamo Caggianelli,Giulia Pellerano,Giuseppina Mollica,Guillermo Bugedo,Hermann Wrigge,Jan-Paul Mulier,Jeroen Vandenbrande,Johann Geib,Jonathan Yaqub,Jorge Florez,Juan Francisco Rangel Mayoral,Juraj Šprung,Jurgen Van Limmen,Lieuwe D. J. Bos,Luc De Baerdemaeker,Luc Jamaer,Luca Spagnolo,Lydia Strys,Manuel Granell,Marcelo Gama de Abreu,Marcos F. Vidal Melo,Marcus J. Schultz,M Carmen Unzueta,María Victoria Moral,Marion Ferner,Markus W. Hollmann,Martin Weiß,Massimo Vanoni,Maximilian S. Schaefer,M. E. Prieto,Michele Grio,Paolo Severgnini,Peter Spieth,Philipp Simon,Phoebe Bodger,P. Sierra,Rita Laufenberg‐Feldmann,Roberta Rusca,R. Proietti,Sabrine N.T. Hemmes,Santi Maurizio Raineri,S Caroleo,Sergi Sabaté,Stefan De Hert,Stefano Pezzato,Tanja A. Treschan,Tatjana Goranović,Thea Koch,Thomas Bluth,Thomas Kiss,Valter Perilli,Tony Gin,W. Schmid,Carlos Ferrando,Javier Belda,Marina Soro,Jaume Canet,Carmen Unzueta,Fernando Suárez-Sipmann,Julián Librero,Alicia Llombart,Lucas Rovira,Manuel Granell,César Aldecoa,Hermann Wrigge,Jaume Balust,Ignacio Garutti,Rafael González,Lucía Gallego,S. García del Valle,Javier Redondo,David Pestaña,Aurelio Rodríguez,Javier García,Manuel de la Matta,Maite Ibáñez,Feliciano Barrios,Samuel Hernández-González,Vicente Torres,Salvador Peiró,Natividad Pozo,Abigail Villena,Albert Carramiñana,Alberto Gallego-Casilda,Alejandro Duca,Amalia Alcón,Amanda Miñana,Ana Asensio,Ana Fanlo Colás,Ana Isabel Galve,Ana Izquierdo,Ana Rosa Jurado,Ana María Pérez,Ana Mugarra,Ana Parera,Andrea Brunelli,Andreas Hoeft,Angeles de Miguel,Angels Lozano,Antonio Katime,A. Romero,B. Garrigues,Begoña Ayas,Blanca Arocas,Carlos Delgado,Carmen Cagigas Fernández,Carolina S. Romero,Clara Gallego,Cristina Garcés,Cristina Lisbona,Cristina Parrilla,Daniel López-Herrera,Domingo González,Eduardo Llamazares,Elena del Río,Elena Carrillo Lozano,Ernesto Pastor Díaz de Garayo,Estefanía Chamorro,Estefanía Gracia,Ester Sánchez,Esther Romero,Fernando Díez,Ferran Serralta,Francisco Daviu,Francisco Sandín,Gerardo Aguilar,Gerardo Tusman,Gonzalo Azparren,Graciela Martinez‐Pallí,Guido Mazzinari,Inmaculada Benítez,Inmaculada Hernandéz,Inmaculada India,Irene León,Isabel Fuentes,Isabel Moreno Ruiz,Jaume Puig,JA Roman,Jesús Acosta,Jesús Rico‐Feijoo,Jonathan Olmedo,J Carbonell,José Marı́a Alonso,José María García Pérez,J.M. Marcos Vidal,José Cerón Navarro,J. Valdivia,Juan Carrizo,Laura Piqueras,L. Lorenzo Soriano,Laura Vaquero,Lisset Miguel,Lorena Rodríguez Muñoz,Lucía Valencia,Luis Olmedilla,Ma Justina Etulain,Manuel Tisner,María Chie Niimura del Barrio,M. D. Alonso,María Bóveda García,María José Mellado,María José Alberola,M. Parra,María Argente,Miguel Vila,Mario De Fez,Marta Agilaga,Marta Giné,Mercedes Ayuso,Mercedes García,Natalia Bejarano Ramírez,Natalia Peña,Nazario Ojeda,Nilda Reyes Martínez,Nuria García,Oto Padrón,Pablo Monedero,Paola Valls,Patrícia Cruz,Patricia Piñeiro,Pedro Charco-Mora,Rafael Anaya,Ramiro de la Prieta López,R Burgos Rodríguez,Rocío Martínez,Roger Pujol,Rosa Dosdá,Rosa Lardies,Rubén Sierra Díaz,R. Villazala,Sara Zapatero,Sergio Cabrera,Sergio Sánchez-García,Silvia Martin,Suzana Diaz,Tania Franco,Tania Moreno,Tania Socorro,Vicente Gilabert,Victor Balandrón,V. Moral,Virgina Cegarra,Viviana Varón,F. Abelha,Sühayla Abitağaoğlu,Marc Achilles,Afeez Adebesin,Ine Adriaensens,Charles Ahene,Fatima Akbar,Mohammed Al Harbi,Rita Kallab,Xavier Albanel,Florence Aldenkortt,Rawan Abdullah Saleh Alfouzan,Reef Alruqaie,Fernando Altermatt,Bruno Luís de Castro Araujo,Genaro Arbesú,Hanna Artsi,Caterina Aurilio,Ömer Ayanoğlu,Alessandro Bacuzzi,Harris Baig,Yolanda Baird,Konstantin Balonov,Jaume Balust,Samantha Banks,Qinqin Xia,Mélanie Baumgartner,Isabel Belda Tortosa,Alice Bergamaschi,Lars Bergmann,Luca M. Bigatello,Elena Biosca Pérez,K. Birr,Thomas Bluth,Elird Bojaxhi,Chiara Maria Bonenti,Iwona Bonney,Elke M.E. Bos,Sara Bowman,Leandro Gobbo Braz,Elisa Brugnoni,Sorin J. Brull,Iole Brunetti,Andrea Bruni,Shonie L. Buenvenida,Cornelius Busch,Giovanni Camerini,Jaume Canet,Beatrice Capatti,J.F. Martínez Carmona,Jaime Carungcong,Márcia Carvalho,Anat Cattan,Carla Cavaleiro,Davide Chiumello,Stefano Ciardo,Mark Coburn,Umberto Colella,Víctor Contreras,Pelin Çorman Dinçer,Elizabeth K. Cotter,Marcia Crovetto,William Culp Darrah,Simon Davies,Luc De Baerdemaeker,Stefan De Hert,Enrique Del Cojo Peces,Ellise Delphin,John G. Laffey,Paulo do Nascimento,Valerio Donatiello,Jing Dong,Maria do Socorro Dourado,Alexander Dullenkopf,Felix Ebner,Hamed Elgendy,Christoph Ellenberger,Dilek Erdoğan Arı,Thomas Ermert,Fadi Farah,Ana Fernandez-Bustamante,Cristina Helena Targa Ferreira,Marco Fiore,Ana Fonte,Christina Fortià Palahí,Andrea Galimberti,Marcelo Gama de Abreu,Najia Garofano,Luca Gregorio Giaccari,F. Gilsanz,Felix Girrbach,Luca Gobbi,Marc B. Godfried,Nicolai Goettel,Peter A. Goldstein,Or Goren,Andrew Gorlin,Manuel Granell,Angelo Gratarola,Juan Graterol,Pierre Guyon,Kevin Haire,Philippe Harou,Antonia Helf,Sabrine N.T. Hemmes,Gunther Hempel,María José Hernández Cádiz,Björn Heyse,Markus W. Hollmann,Iván Huercio,Jasmina Ilievska,Lien Jakus,Vijay Jeganath,Yvonne Jelting,Minoa Jung,Barbara Kabon,Aalok Kacha,Maja Karaman Ilić,Arunthevaraja Karuppiah,Ayşe Duygu Kavas,Gleicy Keli Barcelos,Todd A. Kellogg,Johann Kemper,Romain Kerbrat,Suraya Khodr,Peter Kienbaum,Bünyamin Kır,Thomas Kiss,Selin Kivrak,Vlasta Klarić,Thea Koch,Ceren Köksal,Ana Kowark,Peter Kranke,Bahar Kuvaki,Билјана Кузмановска,John G. Laffey,Mirko Lange,Marília Freitas de Lemos,Marc Licker,Manuel López-Baamonde,Antonio López-Hernández,Mercedes Lopez-Martinez,Stéphane Luise,Mark MacGregor,Danielle Dourado Magalhães,Julien Maillard,Patrizia Malerbi,Natesan Manimekalai,Michael Margarson,Klaus Markstaller,Archer Kilbourne Martin,David P. Martin,Yvette N. Martin,Julia Martínez-Ocón,Ignacio Martín‐Loeches,Emilio Maseda,Idit Matot,Niamh McAuliffe,Omair A. Shariq,Paulina Medina,Melanie Meersch,Angelika Menzen,Els Mertens,Bernd Meurer,Tanja A. Treschan,Changhong Miao,Camilla Micalizzi,Morena Milić,Norma Sueli Pinheiro Módolo,Pierre Moine,Patrick Mölders,Ana Montero-Feijoo,E. Moret,Markus K. Müller,Zoe Murphy,Pramod Nalwaya,Filip Naumovski,Paolo Navalesi,Laís Helena Navarro e Lima,Višnja Nesek Adam,Claudia Neumann,Christopher Newell,Zoulfira Nisnevitch,Junaid Nizamuddin,Cecilia Novazzi,Michael O’Connor,Günther Oprea,Mukadder Orhan Sungur,Şule Özbilgin,Maria Caterina Pace,M. Pacheco,Packianathaswamy Balaji,Estefania Palma Gonzalez,Fotios Papaspyros,Sebastián Paredes,Maria Beatrice Passavanti,Juan C. Pedemonte,Paolo Pelosi,Sanja Peremin,Christoph Philipsenburg,Daniela Pinho,Sílvia Pinho,Linda M. Posthuma,Vincenzo Pota,Benedikt Preckel,P Priani,Christian Putensen,Mohamed Aymen Kraiem Ben Rached,Aleksandar Radoeshki,Riccardo Ragazzi,Tamilselvan Rajamanickam,Arthi Rajamohan,Harish Ramakrishna,Desikan Rangarajan,Christian Reiterer,J. Ross Renew,Thomas Reynaud,Rhys Rhidian,Eva Rivas,Luisa Robitzky,Rolf Rossaint,Francesca Rubulotta,Humberto S Machado,Catarina S. Nunes,Giovanni Sabbatini,Jon D. Samuels,Josep Sanahuja,Pasquale Sansone,Alice Miranda dos Santos,Mohamed Sayedalahl,Maximilian S. Schaefer,Martin Scharffenberg,Eduardo Schiffer,Nadja Schliewe,Raoul Schorer,Marcus J. Schultz,Roman Schumann,Gabriele Selmo,M. Sendra,Mert Şentürk,Paolo Severgnini,Kate Shaw,Mirjana Shosholcheva,Abdulrazak Sibai,Philipp Simon,Francesca Simonassi,Claudia Sinno,Nükhet Sivrikoz,vasiliki skandalou,Neil Smith,Maria Cidney da Silva Soares,Tania Socorro Artiles,Diogo Sousa Castro,Miguel Sousa,Savino Spadaro,Juraj Šprung,Emmanouil Stamatakis,Luzius A. Steiner,Andrea Stevenazzi,Alejandro Suárez-de-la-Rica,Mélanie Suppan,R. Teichmann,José Maria Tena Guerrero,Bram Thiel,Raquel Tolós,Gülbin Töre Altun,Michelle Tucci,Zachary A. Turnbull,Žana Turudić,Matthias Unterberg,Jurgen Van Limmen,Yves Van Nieuwenhove,Julia Van Waesberghe,Marcos Francisco Vidal Melo,Bibiana Vitković,Luigi Vivona,Marcela P. Vizcaychipi,Carlo Alberto Volta,Anne Weber,Toby N. Weingarten,Jakob Wittenstein,Hermann Wrigge,Piet Wyffels,Julio Yagüe,David Yates,Ayşen Yavru,Lilach Zac,Jing Zhong

出处

期刊：BJA: British Journal of Anaesthesia [Elsevier BV]
日期：2022-06-01 卷期号：128 (6): 1040-1051 被引量：28

链接

bjanaesthesia.org nih.govdoi.org

标识

DOI：10.1016/j.bja.2022.02.039

摘要

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).

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