Individualized positive end-expiratory pressure in patients undergoing thoracoscopic lobectomy: a randomized controlled trial

Zhang, Yuying; Zhang, Meng; Wang, Xu’an; Shang, Gaocheng; Dong, Yue

doi:10.1016/j.bjane.2021.04.001

Cited by 2 publications

(5 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We detected a moderate degree of heterogeneity regarding our primary outcome and performed a sensitivity analysis to explore potential reasons for this. The heterogeneity was reduced to 55%, and the mean difference (MD) changed from 44.96 to 51.50 after excluding the study conducted by Zhang et al ( 16 ) The heterogeneity was reduced to 50%, and the MD changed from 44.96 to 51.42 after excluding the study conducted by Park et al ( 1 ) The heterogeneity was reduced to 0%, and the MD changed from 44.96 to 60.62 after excluding both studies ( 1 , 16 ).…”

Section: Resultsmentioning

confidence: 99%

“…Among the included studies, five reported PaO 2 /FiO 2 ratio ( 15 , 17 – 20 ) and two studies reported the PaO 2 and FiO 2 (FiO 2 = 100% for both studies). ( 1 , 16 ) In one study, the PaO 2 /FiO 2 ratio was measured after 15 min of OLV ( 1 ), in another study, it was measured after 20 min of OLV ( 18 ), and in three studies, it was measured after 30 min of OLV ( 15 , 16 , 20 ). Two studies did not mention the specific time of measurement ( 17 , 19 ).…”

Section: Resultsmentioning

confidence: 99%

“…Three studies recorded the PaO 2 /FiO 2 ratio at 0.5 h of OLV, ( 15 , 16 , 20 ) and two studies recorded the PaO 2 /FiO 2 ratio at 1 h of OLV. ( 15 , 20 ) PaO 2 /FiO 2 ratio was higher in the driving pressure-oriented group at 0.5 h.(MD: 35.64; 95% CI, 7.38–63.90; I 2 : 39%; P = 0.01) ( Supplementary Figure S1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Based on the results of sensitivity analysis. We carefully analyzed the differences between the two studies ( 1 , 16 ) and the other studies and concluded that the high heterogeneity may be due to the following: (1) the intraoperative blood gas analyses were conducted at different time points; (2) the number of patients included in the study by Park et al was larger than that in the other studies. Although they were all patients with OLV, there may have been some differences in the baseline characteristics of the patients from other studies; (3) a protective ventilation strategy was adopted for the control group in Park et al’s study ( V T : 6–8 mL/kg IBW, PEEP = 5 cmH 2 O, combined with a certain amount of lung recruitment maneuvers), while in the other included studies, the control group basically adopted conventional ventilation strategies and protective ventilation strategies were not exclusively used; and 4) Zhang et al’s study was designed to titrate PEEP to the best C RS and was not strictly driving pressure-oriented because the driving pressure of the experimental group was statistically significantly lower than that of the control group ( P < 0.01).…”

Section: Discussionmentioning

confidence: 99%

“…There are some more critical clinical outcomes - the ICU length of stay, hospital length of stay, and mortality. However, only one of our included studies recorded hospital length of stay ( 16 ), so we were unable to assess these more valuable clinical outcomes. For the continuous variables, since we considered that the results would be different depending on the time point, we performed a subgroup analysis.…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

Effect of Driving Pressure-Oriented Ventilation on Patients Undergoing One-Lung Ventilation During Thoracic Surgery: A Systematic Review and Meta-Analysis

Li¹,

Xue²,

Zhang³

et al. 2022

Front. Surg.

View full text Add to dashboard Cite

BackgroundHypoxemia and fluctuations in respiratory mechanics parameters are common during one-lung ventilation (OLV) in thoracic surgery. Additionally, the incidence of postoperative pulmonary complications (PPCS) 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 PPCS 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.MethodsWe 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 PaO2/FiO2 ratio (P/F ratio) during OLV. The secondary outcomes were the incidence of PPCS during follow-up, compliance of the respiratory system during OLV, and mean arterial pressure during OLV.ResultsThis review included seven studies, with a total of 640 patients. The PaO2/FiO2 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; I2: 58%; P < 0.0001). The incidence of PPCS was lower (OR: 0.58; 95% CI, 0.34–0.99; I2: 0%; P = 0.04) and the compliance of the respiratory system was higher (MD: 6.15; 95% CI, 3.97–8.32; I2: 57%; P < 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.ConclusionDriving pressure-oriented ventilation during OLV in patients undergoing thoracic surgery was associated with better perioperative oxygenation, fewer PPCS, and improved compliance of the respiratory system.Systematic Review RegistrationPROSPERO, identifier: CRD42021297063.

show abstract