Carron Michele, Tamburini Enrico, Maggiolo Alessandra, Linassi Federico, Sella Nicolò, Navalesi Paolo
Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padua, Gallucci V. St. 13, 35121 Padua, Italy.
Institute of Anesthesia and Intensive Care, Padua University Hospital, Giustiniani St. 2, 35128 Padua, Italy.
J Clin Med. 2025 Mar 18;14(6):2063. doi: 10.3390/jcm14062063.
Managing ventilatory strategies in patients with obesity under general anesthesia presents significant challenges due to obesity-related pathophysiological changes. Inverse ratio ventilation (IRV) has emerged as a potential strategy to optimize respiratory mechanics during laparoscopic surgery in this population. The primary outcomes were changes in respiratory mechanics, including peak inspiratory pressure (P), plateau pressure (P), mean airway pressure (P), and dynamic compliance (C). Secondary outcomes included gas exchange parameters, hemodynamic measures, inflammatory cytokines, and postoperative complications. A systematic review and meta-analysis were conducted, searching PubMed, Scopus, EMBASE, and PMC Central. Only English-language randomized controlled trials (RCTs) evaluating the impact of IRV in adult surgical patients with obesity were included. The quality and certainty of evidence were assessed using the Risk of Bias 2 (RoB 2) tool and the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework, respectively. Three RCTs including 172 patients met the inclusion criteria. Compared to conventional ventilation without prolonged inspiratory time or IRV, IRV significantly reduced P (MD [95%CI]: -3.15 [-3.88; -2.42] cmHO, < 0.001) and P (MD [95%CI]: -3.13 [-3.80; -2.47] cmHO, < 0.001) while increasing P (MD [95%CI]: 4.17 [3.11; 5.24] cmHO, < 0.001) and C (MD [95%CI]: 2.64 [0.95; 4.22] mL/cmHO, = 0.002) during laparoscopy, without significantly affecting gas exchange. IRV significantly reduced mean arterial pressure (MD [95%CI]: -2.93 [-3.95; -1.91] mmHg, < 0.001) and TNF-α levels (MD [95%CI]: -9.65 [-17.89; -1.40] pg/mL, = 0.021). IRV optimizes intraoperative respiratory mechanics but has no significant impact on postoperative outcomes, necessitating further research to determine its clinical role.
由于肥胖相关的病理生理变化，在全身麻醉下管理肥胖患者的通气策略面临重大挑战。反比通气（IRV）已成为优化该人群腹腔镜手术期间呼吸力学的一种潜在策略。主要结局是呼吸力学的变化，包括吸气峰压（P）、平台压（P）、平均气道压（P）和动态顺应性（C）。次要结局包括气体交换参数、血流动力学指标、炎性细胞因子和术后并发症。进行了一项系统评价和荟萃分析，检索了PubMed、Scopus、EMBASE和PMC Central。仅纳入评估IRV对成年肥胖手术患者影响的英文随机对照试验（RCT）。分别使用偏倚风险2（RoB 2）工具和推荐分级、评估、制定与评价（GRADE）框架评估证据的质量和确定性。三项包括172例患者的RCT符合纳入标准。与无延长吸气时间的传统通气或IRV相比，IRV在腹腔镜手术期间显著降低了P（MD [95%CI]：-3.15 [-3.88；-2.42] cmH₂O，P < 0.001）和P（MD [95%CI]：-3.13 [-3.80；-2.47] cmH₂O，P < 0.001），同时增加了P（MD [95%CI]：4.17 [3.11；5.24] cmH₂O，P < 0.001）和C（MD [95%CI]：2.64 [0.95；4.22] mL/cmH₂O，P = 0.002），且对气体交换无显著影响。IRV显著降低了平均动脉压（MD [95%CI]：-2.93 [-3.95；-1.91] mmHg，P < 0.001）和TNF-α水平（MD [95%CI]：-9.65 [-17.89；-1.40] pg/mL，P = 0.021）。IRV可优化术中呼吸力学，但对术后结局无显著影响，需要进一步研究以确定其临床作用。
