The Routine Use of Positive End-Expiratory Pressure after Open Heart Surgery

Good, James T.; Woh, John F.; Anderson, James T.; Dreisin, Robert B.; Petty, Thomas L.

doi:10.1378/chest.76.4.397

Cited by 52 publications

(20 citation statements)

References 11 publications

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“…2). Heterogeneity in the analysis of duration of ventilation was partly caused by one RCT in postsurgical patients [17]. Removing this RCT lowered the heterogeneity ( I 2 = 13%) (Table 2).…”

Section: Resultsmentioning

confidence: 99%

Associations between positive end-expiratory pressure and outcome of patients without ARDS at onset of ventilation: a systematic review and meta-analysis of randomized controlled trials

Neto

Filho

Cherpanath

et al. 2016

Ann. Intensive Care

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BackgroundThe aim of this investigation was to compare ventilation at different levels of positive end-expiratory pressure (PEEP) with regard to clinical important outcomes of intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) at onset of ventilation.MethodsMeta-analysis of randomized controlled trials (RCTs) comparing a lower level of PEEP with a higher level of PEEP was performed. The primary outcome was in-hospital mortality.ResultsTwenty-one RCTs (1393 patients) were eligible. PEEP ranged from 0 to 10 cmH2O and from 5 to 30 cmH2O in the lower PEEP and the higher PEEP arms of included RCTs, respectively. In-hospital mortality was not different between the two PEEP arms in seven RCTs (risk ratio [RR] 0.87; 95% confidence interval [CI] 0.62–1.21; I 2 = 26%, low quality of evidence [QoE]), as was duration of mechanical ventilation in three RCTs (standardized mean difference [SMD] 0.68; 95% CI −0.24 to 1.61; I 2 = 82%, very low QoE). PaO2/FiO2 was higher in the higher PEEP arms in five RCTs (SMD 0.72; 95% CI 0.10–1.35; I 2 = 86%, very low QoE). Development of ARDS and the occurrence of hypoxemia (2 RCTs) were lower in the higher PEEP arms in four RCTs and two RCTs, respectively (RR 0.43; 95% CI 0.21–0.91; I 2 = 56%, low QoE; RR 0.42; 95%–CI 0.19–0.92; I 2 = 19%, low QoE). There was no association between the level of PEEP and any hemodynamic parameter (four RCTs).ConclusionVentilation with higher levels of PEEP in ICU patients without ARDS at onset of ventilation was not associated with lower in-hospital mortality or shorter duration of ventilation, but with a lower incidence of ARDS and hypoxemia, as well as higher PaO2/FiO2. These findings should be interpreted with caution, as heterogeneity was moderate to high, the QoE was low to very low, and the available studies prevented us from addressing the effects of moderate levels of PEEP.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0208-7) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Associations between positive end-expiratory pressure and outcome of patients without ARDS at onset of ventilation: a systematic review and meta-analysis of randomized controlled trials

Neto

Filho

Cherpanath

et al. 2016

Ann. Intensive Care

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“…We can only speculate on the effect of positive end expiratory pressure (PEEP) and/or continuous positive airway pressure (CPAP) treatment that was chosen by some anesthesiologists. Although not directly translatable to our population, CPAP increases post‐operative arterial oxygenation in patients undergoing coronary artery bypass graft surgery . The effect, however, appears to cease when the treatment is discontinued and the methods are incapable of preventing atelectasis .…”

Section: Discussionmentioning

confidence: 97%

Routine pre‐operative focused ultrasonography by anesthesiologists in patients undergoing urgent surgical procedures

Bøtker

Vang

Grøfte

et al. 2014

Acta Anaesthesiol Scand

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“…The EIPP at baseline was 14 cmH 2 O (9-23), with no difference between the three groups. After the interventions EIPP increased (at 0 min) to 22 (16)(17)(18)(19)(20)(21)(22)(23)(24) positive end-expiratory pressure) and 212 AE 66% (P < 0.0001 vs. baseline, P < 0.0001 vs. positive endexpiratory pressure), respectively (Fig. 2).…”

Section: Ventilatory Parametersmentioning

confidence: 94%

“…Ventilatory rate in the three groups at baseline was 18 min À1 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) [median (range)], tidal volume per kilogram bodyweight was 5.3 ml kg À1 (4.3-7.3) and minute ventilation was 7.6 l min À1 (6.5-10.3) with no difference between the groups. These parameters were unchanged 60 min after the interventions.…”

Section: Ventilatory Parametersmentioning

confidence: 99%

Both lung recruitment maneuver and PEEP are needed to increase oxygenation and lung volume after cardiac surgery

Dyhr¹,

Nygård²,

Laursen

et al. 2004

Acta Anaesthesiol Scand

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The Routine Use of Positive End-Expiratory Pressure after Open Heart Surgery

Cited by 52 publications

References 11 publications

Associations between positive end-expiratory pressure and outcome of patients without ARDS at onset of ventilation: a systematic review and meta-analysis of randomized controlled trials

Associations between positive end-expiratory pressure and outcome of patients without ARDS at onset of ventilation: a systematic review and meta-analysis of randomized controlled trials

Routine pre‐operative focused ultrasonography by anesthesiologists in patients undergoing urgent surgical procedures

Both lung recruitment maneuver and PEEP are needed to increase oxygenation and lung volume after cardiac surgery

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