Protocol for a systematic review and individual patient data meta-analysis of benefit of so-called lung-protective ventilation settings in patients under general anesthesia for surgeryReport as inadecuate




Protocol for a systematic review and individual patient data meta-analysis of benefit of so-called lung-protective ventilation settings in patients under general anesthesia for surgery - Download this document for free, or read online. Document in PDF available to download.

Systematic Reviews

, 3:2

First Online: 02 January 2014Received: 13 September 2013Accepted: 10 December 2013DOI: 10.1186-2046-4053-3-2

Cite this article as: Neto, A.S., Hemmes, S.N., de Abreu, M.G. et al. Syst Rev 2014 3: 2. doi:10.1186-2046-4053-3-2

Abstract

BackgroundAlmost all patients under general anesthesia for surgery need mechanical ventilation. The harmful effects of short-term intra-operative ventilation on pulmonary integrity are increasingly recognized. Recent investigations suggest protection against so-called ventilation-associated lung injury with the use of lower tidal volumes and-or the use of higher levels of positive end-expiratory pressure PEEP. This review and meta-analysis will evaluate the effects of these protective measures on pulmonary and extra-pulmonary complications, and try to discriminate the effects of lower tidal volumes from those of higher levels of PEEP.

Methods-designThe Medline database will be searched for observational studies and randomized controlled trials of intra-operative ventilation. Individual patient data will be collected from databases obtained via direct contact with corresponding authors of original articles. The primary endpoint is development of postoperative acute respiratory distress syndrome, the most important postoperative pulmonary complication. Secondary endpoints include hospital length of stay and hospital mortality, and reported intra-operative and postoperative pulmonary and extra-pulmonary complications. Emphasis is put on separating the effects of lower tidal volumes from those of higher levels of PEEP.

DiscussionThis will be the first meta-analysis of intra-operative ventilation using individual patient data from observational studies and randomized controlled trials. The large sample size could allow discrimination of the effect of the two most frequently used protective measures - that is, lower tidal volumes and higher levels of PEEP. The results of this review and meta-analysis can be used in designing future trials of ventilation.

KeywordsSurgery Mechanical ventilation Individual patient data Protective ventilation AbbreviationsARDSAcute respiratory distress syndrome

ASAAmerican Society of Anesthesiology score

FiO2Inspired fraction of oxygen

ILInterleukin

ITTIntention-to-treat

PaCO2Partial pressure of carbon dioxide

PaO2Partial pressure of oxygen

PBWPredicted body weight

PEEPPositive end-expiratory pressure

TNFTumor necrosis factor.

Electronic supplementary materialThe online version of this article doi:10.1186-2046-4053-3-2 contains supplementary material, which is available to authorized users.

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Author: Ary Serpa Neto - Sabrine NT Hemmes - Marcelo Gama de Abreu - Paolo Pelosi - Marcus J Schultz - PROVE Network investigator

Source: https://link.springer.com/







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