Intraoperative ventilatory strategies to prevent postoperative pulmonary complications: a meta-analysis

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Purpose of reviewIt is uncertain whether patients undergoing short-lasting mechanical ventilation for surgery benefit from lung-protective intraoperative ventilatory settings including the use of lower tidal volumes, higher levels of positive end-expiratory pressure (PEEP) and/or recruitment maneuvers. We meta-analyzed trials testing the effect of lung-protective intraoperative ventilatory settings on the incidence of postoperative pulmonary complications.Recent findingsEight articles (1669 patients) were included. Meta-analysis showed a decrease in lung injury development [risk ratio (RR) 0.40; 95% confidence interval (CI) 0.22–0.70; I2 0%; number needed to treat (NNT) 37], pulmonary infection (RR 0.64; 95% CI 0.43–0.97; I2 0%; NNT 27) and atelectasis (RR 0.67; 95% CI 0.47–0.96; I2 48%; NNT 31) in patients receiving intraoperative mechanical ventilation with lower tidal volumes. Meta-analysis also showed a decrease in lung injury development (RR 0.29; 95% CI 0.14–0.60; I2 0%; NNT 29), pulmonary infection (RR 0.62; 95% CI 0.40–0.96; I2 15%; NNT 33) and atelectasis (RR 0.61; 95% CI 0.41–0.91; I2 0%; NNT 29) in patients ventilated with higher levels of PEEP, with or without recruitment maneuvers.SummaryLung-protective intraoperative ventilatory settings have the potential to protect against postoperative pulmonary complications.

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