Comparison of the effects of different positive end-expiratory pressure levels on respiratory mechanics and oxygenation in laparoscopic surgery: A protocol for systematic review and network meta-analyses

BACKGROUND: Several studies have observed the good effects of positive end-expiratory pressure (PEEP) application in laparoscopic surgeries, such as counteracted intraoperative atelectasis, improved respiratory mechanics, and gas exchange. However, evidence of systematic comparisons of different PEEP levels is short, and the optimal level of PEEP during laparoscopy remains unknown and controversial. The study aims to compare the effects of different PEEP levels on respiratory mechanics and oxygenation in laparoscopic surgery using network meta-analyses. METHODS: To identify relevant studies, a systematic search will be conducted among electronic databases, including PubMed, Cochrane Library, EMBASE, and Web of Science. We will include randomized controlled trials (RCTs). The risk of bias in the included RCTs will be assessed using the Cochrane bias risk tool. Network meta-analysis will be performed using STATA 15.0, and R 3.4.1 software. RESULTS: This study is ongoing and the results will be published in a peer-reviewed journal. CONCLUSION: The results of this study will be sent to clinicians and healthcare providers in the National Health Service, which is expected to help clinicians make more informed treatment decisions and facilitate further research on the use of PEEP during surgery. PROSPERO REGISTRATION NUMBER: CRD42018093537.