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Effect of protective lung ventilation on pulmonary complications after laparoscopic surgery: a meta-analysis of randomized controlled trials

INTRODUCTION: Compared with traditional open surgery, laparoscopic surgery is widely used in surgery, with the advantages of being minimally invasive, having good cosmetic effects, and having short hospital stays, but in laparoscopic surgery, pneumoperitoneum and the Trendelenburg position can cause...

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Autores principales: Sun, Menglin, Jia, Ruolin, Wang, Lijuan, Sun, Daqi, Wei, Mingqian, Wang, Tao, Jiang, Lihua, Wang, Yuxia, Yang, Bo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10248173/
https://www.ncbi.nlm.nih.gov/pubmed/37305134
http://dx.doi.org/10.3389/fmed.2023.1171760
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author Sun, Menglin
Jia, Ruolin
Wang, Lijuan
Sun, Daqi
Wei, Mingqian
Wang, Tao
Jiang, Lihua
Wang, Yuxia
Yang, Bo
author_facet Sun, Menglin
Jia, Ruolin
Wang, Lijuan
Sun, Daqi
Wei, Mingqian
Wang, Tao
Jiang, Lihua
Wang, Yuxia
Yang, Bo
author_sort Sun, Menglin
collection PubMed
description INTRODUCTION: Compared with traditional open surgery, laparoscopic surgery is widely used in surgery, with the advantages of being minimally invasive, having good cosmetic effects, and having short hospital stays, but in laparoscopic surgery, pneumoperitoneum and the Trendelenburg position can cause complications, such as atelectasis. Recently, several studies have shown that protective lung ventilation strategies are protective for abdominal surgery, reducing the incidence of postoperative pulmonary complications (PPCs). Ventilator-associated lung injury can be reduced by protective lung ventilation, which includes microtidal volume (4–8 mL/kg) ventilation and positive end-expiratory pressure (PEEP). Therefore, we used randomized, controlled trials (RCTs) to assess the results on this topic, and RCTs were used for meta-analysis to further evaluate the effect of protective lung ventilation on pulmonary complications in patients undergoing laparoscopic surgery. METHODS: In this meta-analysis, we searched the relevant literature contained in six major databases—CNKI, CBM, Wanfang Medical, Cochrane, PubMed, and Web of Science—from their inception to October 15, 2022. After screening the eligible literature, a randomized, controlled method was used to compare the occurrence of postoperative pulmonary complications when a protective lung ventilation strategy and conventional lung ventilation strategy were applied to laparoscopic surgery. After statistical analysis, the results were verified to be statistically significant. RESULTS: Twenty-three trials were included. Patients receiving protective lung ventilation were 1.17 times less likely to develop pulmonary complications after surgery than those receiving conventional lung ventilation (hazard ratio [RR] 0.18, 95% confidence interval [CI] 1.13–1.22; I(2) = 0%). When tested for bias (P = 0.36), the result was statistically significant. Patients with protective lung ventilation were less likely to develop pulmonary complications after laparoscopic surgery. CONCLUSION: Compared with conventional mechanical ventilation, protective lung ventilation reduces the incidence of postoperative pulmonary complications. For patients undergoing laparoscopic surgery, we suggest the use of protective lung ventilation, which is effective in reducing the incidence of lung injury and pulmonary infection. Implementation of a low tidal volume plus moderate positive end-expiratory pressure strategy reduces the risk of postoperative pulmonary complications.
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spelling pubmed-102481732023-06-09 Effect of protective lung ventilation on pulmonary complications after laparoscopic surgery: a meta-analysis of randomized controlled trials Sun, Menglin Jia, Ruolin Wang, Lijuan Sun, Daqi Wei, Mingqian Wang, Tao Jiang, Lihua Wang, Yuxia Yang, Bo Front Med (Lausanne) Medicine INTRODUCTION: Compared with traditional open surgery, laparoscopic surgery is widely used in surgery, with the advantages of being minimally invasive, having good cosmetic effects, and having short hospital stays, but in laparoscopic surgery, pneumoperitoneum and the Trendelenburg position can cause complications, such as atelectasis. Recently, several studies have shown that protective lung ventilation strategies are protective for abdominal surgery, reducing the incidence of postoperative pulmonary complications (PPCs). Ventilator-associated lung injury can be reduced by protective lung ventilation, which includes microtidal volume (4–8 mL/kg) ventilation and positive end-expiratory pressure (PEEP). Therefore, we used randomized, controlled trials (RCTs) to assess the results on this topic, and RCTs were used for meta-analysis to further evaluate the effect of protective lung ventilation on pulmonary complications in patients undergoing laparoscopic surgery. METHODS: In this meta-analysis, we searched the relevant literature contained in six major databases—CNKI, CBM, Wanfang Medical, Cochrane, PubMed, and Web of Science—from their inception to October 15, 2022. After screening the eligible literature, a randomized, controlled method was used to compare the occurrence of postoperative pulmonary complications when a protective lung ventilation strategy and conventional lung ventilation strategy were applied to laparoscopic surgery. After statistical analysis, the results were verified to be statistically significant. RESULTS: Twenty-three trials were included. Patients receiving protective lung ventilation were 1.17 times less likely to develop pulmonary complications after surgery than those receiving conventional lung ventilation (hazard ratio [RR] 0.18, 95% confidence interval [CI] 1.13–1.22; I(2) = 0%). When tested for bias (P = 0.36), the result was statistically significant. Patients with protective lung ventilation were less likely to develop pulmonary complications after laparoscopic surgery. CONCLUSION: Compared with conventional mechanical ventilation, protective lung ventilation reduces the incidence of postoperative pulmonary complications. For patients undergoing laparoscopic surgery, we suggest the use of protective lung ventilation, which is effective in reducing the incidence of lung injury and pulmonary infection. Implementation of a low tidal volume plus moderate positive end-expiratory pressure strategy reduces the risk of postoperative pulmonary complications. Frontiers Media S.A. 2023-05-25 /pmc/articles/PMC10248173/ /pubmed/37305134 http://dx.doi.org/10.3389/fmed.2023.1171760 Text en Copyright © 2023 Sun, Jia, Wang, Sun, Wei, Wang, Jiang, Wang and Yang. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Sun, Menglin
Jia, Ruolin
Wang, Lijuan
Sun, Daqi
Wei, Mingqian
Wang, Tao
Jiang, Lihua
Wang, Yuxia
Yang, Bo
Effect of protective lung ventilation on pulmonary complications after laparoscopic surgery: a meta-analysis of randomized controlled trials
title Effect of protective lung ventilation on pulmonary complications after laparoscopic surgery: a meta-analysis of randomized controlled trials
title_full Effect of protective lung ventilation on pulmonary complications after laparoscopic surgery: a meta-analysis of randomized controlled trials
title_fullStr Effect of protective lung ventilation on pulmonary complications after laparoscopic surgery: a meta-analysis of randomized controlled trials
title_full_unstemmed Effect of protective lung ventilation on pulmonary complications after laparoscopic surgery: a meta-analysis of randomized controlled trials
title_short Effect of protective lung ventilation on pulmonary complications after laparoscopic surgery: a meta-analysis of randomized controlled trials
title_sort effect of protective lung ventilation on pulmonary complications after laparoscopic surgery: a meta-analysis of randomized controlled trials
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10248173/
https://www.ncbi.nlm.nih.gov/pubmed/37305134
http://dx.doi.org/10.3389/fmed.2023.1171760
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