Driving pressure-guided PEEP titration for intraoperative mechanical ventilation:a meta-analysis / 重庆医学

ABSTRACT

Objective To systematic evaluate the effectiveness and safety of driving pressure-guided fixed positive end-expiratory pressure(PEEP)titration in intraoperative mechanical ventilation.Methods PubMed,Web of Science,the Cochrane Library,Embase,CNKI,Wanfang and VIP databases were searched for collect randomized controlled trials(RCTs)of PEEP titration guided by driving pressure in intraoperative mechanical ventilation from inception to November 8,2023.After two researchers independently screened the literature,extracted data,and evaluated the risk of bias of the included studies,the meta-analysis was conducted by Rev-Man 5.4 software.Results Nineteen studies with a total of 2 906 patients were included.There were 1 440 patients in the study group with the lung protective ventilation strategy guided by PEEP titration,and 1 466 patients in the control group with the traditional lung protective ventilation strategy.Compared with the con-trol group,the incidence of postoperative pulmonary complications(PPCs)in the study group was lower in the non-thoracic surgery(RR=0.53,95%CI:0.43-0.65,P<0.001),but there was no statistical difference in the incidence of PPCS in the thoracic surgery(RR=0.89,95%CI:0.78-1.02,P=0.09).Compared with the control group,the intraoperative lung compliance was increased(MD= 6.90 L/cmH2O,95%CI:5.80-7.99,P<0.001),and the length of hospital stay was shortened in the study group(MD=-0.27 d,95%CI:-0.43 to-0.12,P<0.001),while there was no significant difference in intraoperative mean arterial pres-sure(MAP)between the two groups(MD=0.36 mmHg,95%CI:-1.30 to 2.01,P=0.67).Conclusion Com-pared with the traditional lung protective ventilation,driving pressure-guided PEEP titration ventilation can im-prove intraoperative lung compliance,reduce the incidence of PPCs in non-thoracic surgery,shorten the length of hospital stay,and does not increase the risk of hemodynamic disturbances in patients undergoing surgery.