Department of Anaesthesiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China.
Br J Anaesth. 2020 Mar;124(3):324-335. doi: 10.1016/j.bja.2019.10.024. Epub 2020 Jan 30.
The debate on lung-protective ventilation strategies for surgical patients is ongoing. Evidence suggests that the use of low tidal volume V improves clinical outcomes. However, the optimal levels of PEEP and recruitment manoeuvre (RM) strategies incorporated into low V ventilation remain unclear.
Several electronic databases were searched to identify RCTs that focused on comparison between low V strategy and conventional mechanical ventilation (CMV), or between two different low V strategies in surgical patients. The primary outcome was postoperative pulmonary complications (PPCs). The secondary outcomes were atelectasis, pneumonia, acute respiratory distress syndrome, and short-term mortality. Bayesian network meta-analyses were performed using WinBUGS. The odds ratios (ORs) and corresponding 95% credible intervals (CrIs) were estimated.
Compared with CMV, low V ventilation with moderate-to-high PEEP reduced the risk of PPCs (moderate PEEP [5-8 cm HO]: OR 0.50 [95% CrI: 0.28, 0.89]; moderate PEEP+RMs: 0.39 [0.19, 0.78]; and high PEEP [≥9 cm HO]+RMs: 0.34 [0.14, 0.79]). Low V ventilation with moderate-to-high PEEP and RMs also specifically reduced the risk of atelectasis compared with CMV (moderate PEEP+RMs: OR 0.36 [95% CrI: 0.16, 0.87]; and high PEEP+RMs: 0.41 [0.15, 0.97]), whilst low V ventilation with moderate PEEP was superior to CMV in reducing the risk of pneumonia (OR 0.46 [95% CrI: 0.15, 0.94]).
The combination of low V ventilation and moderate-to-high PEEP (≥5 cm HO) seems to confer lung protection in surgical patients undergoing general anaesthesia.
PROSPERO (CRD42019144561).
关于手术患者肺保护性通气策略的争论仍在继续。有证据表明，使用小潮气量 V 可改善临床结局。然而，低 V 通气中纳入的最佳 PEEP 和复张手法（RM）策略水平仍不清楚。
检索了多个电子数据库，以确定侧重于比较低 V 策略与常规机械通气（CMV）或手术患者两种不同低 V 策略之间的 RCT。主要结局是术后肺部并发症（PPCs）。次要结局是肺不张、肺炎、急性呼吸窘迫综合征和短期死亡率。使用 WinBUGS 进行贝叶斯网络荟萃分析。估计了比值比（ORs）和相应的 95%可信区间（CrIs）。
与 CMV 相比，中至高 PEEP 的低 V 通气可降低 PPCs 的风险（中 PEEP [5-8 cm HO]：OR 0.50 [95% CrI：0.28, 0.89]；中 PEEP+RMs：0.39 [0.19, 0.78]；高 PEEP [≥9 cm HO]+RMs：0.34 [0.14, 0.79]）。中至高 PEEP 和 RMs 的低 V 通气也可特异性降低与 CMV 相比的肺不张风险（中 PEEP+RMs：OR 0.36 [95% CrI：0.16, 0.87]；高 PEEP+RMs：0.41 [0.15, 0.97]），而中 PEEP 的低 V 通气在降低肺炎风险方面优于 CMV（OR 0.46 [95% CrI：0.15, 0.94]）。
在接受全身麻醉的手术患者中，低 V 通气与中至高 PEEP（≥5 cm HO）的联合似乎可提供肺部保护。
PROSPERO（CRD42019144561）。
