驱动压力导向通气对胸外科单肺通气患者的影响：一项系统评价和荟萃分析
Effect of Driving Pressure-Oriented Ventilation on Patients Undergoing One-Lung Ventilation During Thoracic Surgery: A Systematic Review and Meta-Analysis.
作者信息
Li Xuan, Xue Wenqiang, Zhang Qinyu, Zhu Yuyang, Fang Yu, Huang Jie
机构信息
Department of Anesthesiology, The First Affiliated Hospital of Kunming Medical University, KunMing, China.
出版信息
Front Surg. 2022 May 27;9:914984. doi: 10.3389/fsurg.2022.914984. eCollection 2022.
BACKGROUND
Hypoxemia and fluctuations in respiratory mechanics parameters are common during one-lung ventilation (OLV) in thoracic surgery. Additionally, the incidence of postoperative pulmonary complications (PPC) in thoracic surgery is higher than that in other surgeries. Previous studies have demonstrated that driving pressure-oriented ventilation can reduce both mortality in patients with acute respiratory distress syndrome (ARDS) and the incidence of PPC in patients undergoing general anesthesia. Our aim was to determine whether driving pressure-oriented ventilation improves intraoperative physiology and outcomes in patients undergoing thoracic surgery.
METHODS
We searched MEDLINE via PubMed, Embase, Cochrane, Web of Science, and ClinicalTrials.gov and performed a meta-analysis to compare the effects of driving pressure-oriented ventilation with other ventilation strategies on patients undergoing OLV. The primary outcome was the PaO/FiO ratio (P/F ratio) during OLV. The secondary outcomes were the incidence of PPC during follow-up, compliance of the respiratory system during OLV, and mean arterial pressure during OLV.
RESULTS
This review included seven studies, with a total of 640 patients. The PaO/FiO ratio was higher during OLV in the driving pressure-oriented ventilation group (mean difference [MD]: 44.96; 95% confidence interval [CI], 24.22-65.70.32; : 58%; < 0.0001). The incidence of PPC was lower (OR: 0.58; 95% CI, 0.34-0.99; : 0%; = 0.04) and the compliance of the respiratory system was higher (MD: 6.15; 95% CI, 3.97-8.32; : 57%; < 0.00001) in the driving pressure-oriented group during OLV. We did not find a significant difference in the mean arterial pressure between the two groups.
CONCLUSION
Driving pressure-oriented ventilation during OLV in patients undergoing thoracic surgery was associated with better perioperative oxygenation, fewer PPC, and improved compliance of the respiratory system.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, identifier: CRD42021297063.
背景
在胸外科手术的单肺通气（OLV）过程中，低氧血症和呼吸力学参数波动很常见。此外，胸外科手术后肺部并发症（PPC）的发生率高于其他手术。先前的研究表明，以驱动压为导向的通气可降低急性呼吸窘迫综合征（ARDS）患者的死亡率以及全身麻醉患者的PPC发生率。我们的目的是确定以驱动压为导向的通气是否能改善胸外科手术患者的术中生理状况和预后。
方法
我们通过PubMed、Embase、Cochrane、科学网和ClinicalTrials.gov检索MEDLINE，并进行荟萃分析，以比较以驱动压为导向的通气与其他通气策略对接受OLV患者的影响。主要结局是OLV期间的动脉血氧分压/吸入氧浓度比（P/F比）。次要结局是随访期间PPC的发生率、OLV期间呼吸系统的顺应性以及OLV期间的平均动脉压。
结果
本综述纳入了7项研究，共640例患者。以驱动压为导向的通气组在OLV期间的P/F比更高（平均差值[MD]：44.96；95%置信区间[CI]，24.22 - 65.70；I²：58%；P < 0.0001）。在OLV期间，以驱动压为导向的组PPC发生率更低（OR：0.58；95% CI，0.34 - 0.99；I²：0%；P = 0.04），呼吸系统顺应性更高（MD：6.15；95% CI，3.97 - 8.32；I²：57%；P < 0.00001）。我们未发现两组之间平均动脉压有显著差异。
结论
胸外科手术患者在OLV期间采用以驱动压为导向的通气与更好的围手术期氧合、更少的PPC以及改善的呼吸系统顺应性相关。
系统评价注册
PROSPERO，标识符：CRD42021297063。
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