6533b823fe1ef96bd127f672

RESEARCH PRODUCT

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

Niklas S. CamposThomas BluthSabrine N.t. HemmesJulian LibreroNatividad PozoCarlos FerrandoLorenzo BallGuido MazzinariPaolo PelosiMarcelo Gama De AbreuMarcus J. SchultzA. Serpa NetoSabrine Nt. HemmesMarcelo Gama De AbreuPaolo SevergniniMarkus W. HollmannJan M. BinnekadeHermann WriggeJaume CanetMichael HiesmayrWerner SchmidEdda TschernkoSamir JaberGöran HedenstiernaChristian PutensenPaolo PelosiMarcus J. SchultzAgnes MartiAlessandro BacuzziAlexander BrodhunAlexandre MolinAlfred MertenAna PareraAndrea BrunelliAndrea CortegianiAndreas GüldnerAndreas W. ReskeAngelo GratarolaAntonino GiarratanoBea BastinBjorn HeyseBranka Mazul-sunkoBruno AmanteaBruno BarberisChristian PutensenChristopher UhligConrado Minguez MarínCristian CelentanoDaniela La BellaDavid D’antiniDavid VelgheDemet SulemanjiEdoardo De RobertisEric HartmannFrancesca MontaltoFrancesco TropeaGary H. MillsGilda CinnellaGiorgio Della RoccaGirolamo CaggianelliGiulia PelleranoGiuseppina MollicaGuillermo BugedoHermann WriggeJan-paul MulierJeroen VandenbrandeJohann GeibJonathan YaqubJorge FlorezJuan F. MayoralJuraj SprungJurgen Van LimmenLieuwe Dj. BosLuc De BaerdemaekerLuc JamaerLuigi SpagnoloLydia StrysManuel Granell GilMarcelo Gama De AbreuMarcos F. Vidal MeloMarcus J. SchultzMaria Carmen UnzuetaMaria Victoria MoralMarion FernerMarkus W. HollmannMartin WeissMassimo VanoniMaximilian S. SchaeferMercè PrietoMichele GrioPaolo SevergniniPeter Markus SpiethPhilipp SimonPhoebe BodgerPilar SierraRita Laufenberg-feldmannRoberta RuscaRodolfo ProiettiSabrine Nt. HemmesSanti Maurizio RaineriSanto CaroleoSergi SabatéStefan De HertStefano PezzatoTanja A. TreschanTatjana GoranovicThea KochThomas BluthThomas KissValter PerilliVirginia CegarraWerner SchmidCarlos FerrandoJavier BeldaMarina SoroJaume CanetCarmen UnzuetaFernando Suarez-sipmannJulián LibreroAlicia LlombartLucas RoviraManuel GranellCésar AldecoaOscar Diaz-cambroneroJaume BalustIgnacio GaruttiRafael GonzalezLucia GallegoSantiago Garcia Del ValleJavier RedondoDavid PestañaAurelio RodríguezJavier GarcíaManuel De La MattaMaite IbáñezFrancisco BarriosSamuel HernándezVicente TorresSalvador PeiróNatividad PozoAbigail VillenaAlbert CarramiñanaAlberto Gallego-casildaAlejandro DucaAmalia AlcónAmanda MiñanaAna AsensioAna ColásAna Isabel GalveAna IzquierdoAna JuradoAna María PérezAna MugarraAna PareraAndrea BrunelliAndrea GutierrezÁNgeles De MiguelAngels LozanoAntonio KatimeAntonio RomeroBeatriz GarriguesBegoña AyasBlanca ArocasCarlos DelgadoCarmen FernándezCarolina RomeroClara GallegoCristina GarcésCristina LisbonaCristina ParrillaDaniel López-herreraDomingo GonzálezEduardo LlamazaresElena Del RioElena LozanoErnesto PastorEstefanía ChamorroEstefanía GraciaEster SánchezEsther RomeroFernando DíezFerran SerraltaFrancisco DaviuFrancisco SandínGerardo AguilarGerardo TusmanGonzalo AzparrenGraciela Martínez-pallíGuido MazzinariInmaculada BenítezInmaculada HernandézInmaculada IndiaIrene LeónIsabel FuentesIsabel RuizJaume PuigJavie Ignacio RománJesús AcostaJesús Rico-feijooJonathan OlmedoJose A. CarbonellJose M. AlonsoJose María PérezJose Miguel MarcosJose NavarroJose ValdiviaJuan CarrizoLaura PiquerasLaura SorianoLaura VaqueroLisset MiguelLorena MuñozLucia ValenciaLuis OlmedillaMᵃ Justina EtulainManuel TisnerMaría BarrioMaría Dolores AlonsoMaría GarcíaMaría J. HernándezMaría José AlberolaMaría ParraMaría Pilar ArgenteMaría VilaMario De FezMarta AgilagaMarta GineMercedes AyusoMercedes GarcíaNatalia BejaranoNatalia PeñaNazario OjedaNilda MartínezNuria GarcíaOto PadrónPablo GarcíaPaola VallsPatricia CruzPatricia PiñeiroPedro CharcoRafael AnayaRamiro LópezRayco RodríguezRocío MartínezRoger PujolRosa DosdáRosa LardiesRuben DíazRubén VillazalaSara ZapateroSergio CabreraSergio SánchezSilvia MartinSuzana DiazTania FrancoTania MorenoTania SocorroVicente GilabertVictor BalandrónVictoria MoralVirgina CegarraViviana VarónFernando AbelhaSühayla AbitağaoğluMarc AchillesAfeez AdebesinIne AdriaensensCharles AheneFatima AkbarMohammed Al HarbiRita Al Khoury Al KallabXavier AlbanelFlorence AldenkorttRawan Abdullah Saleh AlfouzanReef AlruqaieFernando AltermattBruno Luís De Castro AraujoGenaro ArbesúHanna ArtsiCaterina AurilioOmer Hilmi AyanogluAlessandro BacuzziHarris BaigYolanda BairdKonstantin BalonovJaume BalustSamantha BanksXiaodong BaoMélanie BaumgartnerIsabel Belda TortosaAlice BergamaschiLars BergmannLuca BigatelloElena Biosca PérezKatja BirrThomas BluthElird BojaxhiChiara BonentiIwona BonneyElke M.e. BosSara BowmanLeandro Gobbo BrazElisa BrugnoniSorin J. BrullIole BrunettiAndrea BruniShonie L. BuenvenidaCornelius Johannes BuschGiovanni CameriniJaume CanetBeatrice CapattiJaviera CarmonaJaime CarungcongMarta CarvalhoAnat CattanCarla CavaleiroDavide ChiumelloStefano CiardoMark CoburnUmberto ColellaVictor ContrerasPelin Corman DincerElizabeth CotterMarcia CrovettoWilliam DarrahSimon DaviesLuc De BaerdemaekerStefan De HertEnrique Del Cojo PecesEllise DelphinJohn DiaperPaulo Do Nascimento JuniorValerio DonatielloJing DongMaria Do Socorro DouradoAlexander DullenkopfFelix EbnerHamed ElgendyChristoph EllenbergerDilek Erdoğan ArıThomas ErmertFadi FarahAna Fernandez-bustamanteCristina FerreiraMarco FioreAna FonteChristina Fortià PalahíAndrea GalimbertiMarcelo Gama De AbreuNajia GarofanoLuca Gregorio GiaccariFernando GilsanzFelix GirrbachLuca GobbiMarc Bernard GodfriedNicolai GoettelPeter A. GoldsteinOr GorenAndrew GorlinManuel Granell GilAngelo GratarolaJuan GraterolPierre GuyonKevin HairePhilippe HarouAntonia HelfSabrine N.t. HemmesGunther HempelMaría José Hernández CádizBjörn HeyseMarkus W. HollmannIvan HuercioJasmina IlievskaLien JakusVijay JeganathYvonne JeltingMinoa JungBarbara KabonAalok KachaMaja Karaman IlićArunthevaraja KaruppiahAyse Duygu KavasGleicy Keli BarcelosTodd A. KelloggJohann KemperRomain KerbratSuraya KhodrPeter KienbaumBunyamin KirThomas KissSelin KivrakVlasta KlarićThea KochCeren KöksalAna KowarkPeter KrankeBahar KuvakiBiljana KuzmanovskaJohn LaffeyMirko LangeMarília Freitas De LemosMarc-joseph LickerManuel López-baamondeAntonio López-hernándezMercedes Lopez-martinezStéphane LuiseMark MacgregorDanielle MagalhãesJulien MaillardPatrizia MalerbiNatesan ManimekalaiMichael MargarsonKlaus MarkstallerArcher K. MartinDavid P. MartinYvette N. MartinJulia Martínez-oconIgnacio Martin-loechesEmilio MasedaIdit MatotNiamh McauliffeTravis J. MckenziePaulina MedinaMelanie MeerschAngelika MenzenEls MertensBernd MeurerTanja Meyer-treschanChanghong MiaoCamilla MicalizziMorena MilićNorma Sueli Pinheiro MódoloPierre MoinePatrick MöldersAna Montero-feijooEnrique MoretMarkus K. MullerZoe MurphyPramod NalwayaFilip NaumovskiPaolo NavalesiLais Helena Navarro E LimaVišnja Nesek AdamClaudia NeumannChristopher NewellZoulfira NisnevitchJunaid NizamuddinCecilia NovazziMichael O'connorGünther OpreaMukadder Orhan SungurŞUle ÖZbilginMaria Caterina PaceMarcos PachecoBalaji PackianathaswamyEstefania Palma GonzalezFotios PapaspyrosSebastián ParedesMaria Beatrice PassavantiJuan Cristobal PedemontePaolo PelosiSanja PereminChristoph PhilipsenburgDaniela PinhoSilvia PinhoLinda M. PosthumaVincenzo PotaBenedikt PreckelPaolo PrianiChristian PutensenMohamed Aymen RachedAleksandar RadoeshkiRiccardo RagazziTamilselvan RajamanickamArthi RajamohanHarish RamakrishnaDesikan RangarajanChristian ReitererJ. Ross RenewThomas ReynaudRhidian RhysEva RivasLuisa RobitzkyRolf RossaintFrancesca RubulottaHumberto S. MachadoCatarina S. NunesGiovanni SabbatiniJon D. SamuelsJosep Martí SanahujaPasquale SansoneAlice SantosMohamed SayedalahlMaximilian S. SchaeferMartin ScharffenbergEduardo SchifferNadja SchlieweRaoul SchorerMarcus J. SchultzRoman SchumannGabriele SelmoMar SendraMert SenturkPaolo SevergniniKate ShawMirjana ShosholchevaAbdulrazak SibaiPhilipp SimonFrancesca SimonassiClaudia SinnoNukhet SivrikozVasiliki SkandalouNeil SmithMaria SoaresTania Socorro ArtilesDiogo Sousa CastroMiguel SousaSavino SpadaroJuraj SprungEmmanouil StamatakisLuzius A. SteinerAndrea StevenazziAlejandro Suarez-de-la-ricaMélanie SuppanRobert TeichmannJosé Maria Tena GuerreroBram ThielRaquel TolósGulbin Tore AltunMichelle TucciZachary A. TurnbullŽAna TurudićMatthias UnterbergJurgen Van LimmenYves Van NieuwenhoveJulia Van WaesbergheMarcos Francisco Vidal MeloBibiana VitkovićLuigi VivonaMarcela VizcaychipiCarlo Alberto VoltaAnne WeberToby N. WeingartenJakob WittensteinHermann WriggePiet WyffelsJulio YagüeDavid YatesAyşen YavruLilach ZacJing Zhong

subject

AdultLung Diseases*PEEP*postoperative pulmonary complicationsmechanical ventilationPositive-Pressure RespirationsurgeryAnesthesiology and Pain MedicinePostoperative ComplicationsTidal Volume*surgeryHumanspostoperative pulmonary complicationsPostoperative Period*mechanical ventilationmechanical ventilation; PEEP; postoperative pulmonary complications; surgery; Adult; Humans; Lung; Postoperative Complications; Postoperative Period; Randomized Controlled Trials as Topic; Tidal Volume; Lung Diseases; Positive-Pressure RespirationLungPEEPRandomized Controlled Trials as Topic

description

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).

yearjournalcountryeditionlanguage
2022-06-01
10.1016/j.bja.2022.02.039https://pure.amc.nl/en/publications/intraoperative-positive-endexpiratory-pressure-and-postoperative-pulmonary-complications(ca1ae8c6-ce47-45e2-bd31-80e46ca6d53c).html