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Tytuł pozycji:

Impact of a positive end-expiratory pressure strategy on oxygenation, respiratory compliance, and hemodynamics during laparoscopic surgery in non-obese patients: a systematic review and meta-analysis of randomized controlled trials.

Tytuł:
Impact of a positive end-expiratory pressure strategy on oxygenation, respiratory compliance, and hemodynamics during laparoscopic surgery in non-obese patients: a systematic review and meta-analysis of randomized controlled trials.
Autorzy:
Yessenbayeva GA; National Research Oncology Center, Astana, Kazakhstan.
Yukhnevich YA; Karaganda Medical University, Karaganda, Kazakhstan.
Khamitova ZK; National Research Oncology Center, Astana, Kazakhstan.
Kim SI; Multidisciplinary hospitals named after Professor H.J.Makazhanov, Karaganda, Kazakhstan.
Zhumabayev MB; National Research Oncology Center, Astana, Kazakhstan.; Astana Medical University, Astana, Kazakhstan.
Berdiyarova GS; Kazakh-Russian Medical University, Almaty, Kazakhstan.
Shalekenov SB; National Research Oncology Center, Astana, Kazakhstan.
Mukatova IY; Astana Medical University, Astana, Kazakhstan.
Yaroshetskiy AI; Pulmonology Department, Sechenov First Moscow State Medical University (Sechenov University, 8/2, Trubetskaya str. 119991, Moscow, Russia. .
Źródło:
BMC anesthesiology [BMC Anesthesiol] 2023 Nov 11; Vol. 23 (1), pp. 371. Date of Electronic Publication: 2023 Nov 11.
Typ publikacji:
Meta-Analysis; Systematic Review; Journal Article
Język:
English
Imprint Name(s):
Original Publication: [London] : BioMed Central, 2001-
MeSH Terms:
Respiratory Distress Syndrome*
Laparoscopy*
Humans ; Randomized Controlled Trials as Topic ; Positive-Pressure Respiration ; Hemodynamics
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Contributed Indexing:
Keywords: Compliance; Laparoscopic Surgery; Lung protective ventilation; Meta-analysis; Non-obese; Oxygenation; PEEP; Pneumoperitoneum; Positive end-expiratory pressure
Entry Date(s):
Date Created: 20231110 Date Completed: 20231113 Latest Revision: 20231113
Update Code:
20240105
PubMed Central ID:
PMC10638810
DOI:
10.1186/s12871-023-02337-0
PMID:
37950169
Czasopismo naukowe
Background: Higher positive end-expiratory pressure (PEEP) during laparoscopic surgery may increase oxygenation and respiratory compliance. This meta-analysis aimed to compare the impact of different intraoperative PEEP strategies on arterial oxygenation, compliance, and hemodynamics during laparoscopic surgery in non-obese patients.
Methods: We searched RCTs in PubMed, Cochrane Library, Web of Science, and Google Scholar from January 2012 to April 2022 comparing the different intraoperative PEEP (Low PEEP (LPEEP): 0-4 mbar; Moderate PEEP (MPEEP): 5-8 mbar; high PEEP (HPEEP): >8 mbar; individualized PEEP - iPEEP) on arterial oxygenation, respiratory compliance (Cdyn), mean arterial pressure (MAP), and heart rate (HR). We calculated mean differences (MD) with 95% confidence intervals (CI), and predictive intervals (PI) using random-effects models. The Cochrane Bias Risk Assessment Tool was applied.
Results: 21 RCTs (n = 1554) met the inclusion criteria. HPEEP vs. LPEEP increased PaO 2 (+ 29.38 [16.20; 42.56] mmHg, p < 0.0001) or PaO 2 /FiO 2 (+ 36.7 [+ 2.23; +71.70] mmHg, p = 0.04). HPEEP vs. MPEEP increased PaO 2 (+ 22.00 [+ 1.11; +42.88] mmHg, p = 0.04) or PaO 2 /FiO 2 (+ 42.7 [+ 2.74; +82.67] mmHg, p = 0.04). iPEEP vs. MPEEP increased PaO 2 /FiO 2 (+ 115.2 [+ 87.21; +143.20] mmHg, p < 0.001). MPEEP vs. LPEP, and HPEEP vs. MPEEP increased PaO 2 or PaO 2 /FiO 2 significantly with different heterogeneity. HPEEP vs. LPEEP increased Cdyn (+ 7.87 [+ 1.49; +14.25] ml/mbar, p = 0.02). MPEEP vs. LPEEP, and HPEEP vs. MPEEP did not impact Cdyn (p = 0.14 and 0.38, respectively). iPEEP vs. LPEEP decreased driving pressure (-4.13 [-2.63; -5.63] mbar, p < 0.001). No significant differences in MAP or HR were found between any subgroups.
Conclusion: HPEEP and iPEEP during PNP in non-obese patients could promote oxygenation and increase Cdyn without clinically significant changes in MAP and HR. MPEEP could be insufficient to increase respiratory compliance and improve oxygenation. LPEEP may lead to decreased respiratory compliance and worsened oxygenation.
Prospero Registration: CRD42022362379; registered October 09, 2022.
(© 2023. The Author(s).)

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