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Effect of Driving Pressure-Oriented Ventilation on Patients Undergoing One-Lung Ventilation During Thoracic Surgery: A Systematic Review and Meta-Analysis

BACKGROUND: Hypoxemia and fluctuations in respiratory mechanics parameters are common during one-lung ventilation (OLV) in thoracic surgery. Additionally, the incidence of postoperative pulmonary complications (PPC(S)) in thoracic surgery is higher than that in other surgeries. Previous studies have...

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Autores principales: Li, Xuan, Xue, Wenqiang, Zhang, Qinyu, Zhu, Yuyang, Fang, Yu, Huang, Jie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9198650/
https://www.ncbi.nlm.nih.gov/pubmed/35722525
http://dx.doi.org/10.3389/fsurg.2022.914984
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author Li, Xuan
Xue, Wenqiang
Zhang, Qinyu
Zhu, Yuyang
Fang, Yu
Huang, Jie
author_facet Li, Xuan
Xue, Wenqiang
Zhang, Qinyu
Zhu, Yuyang
Fang, Yu
Huang, Jie
author_sort Li, Xuan
collection PubMed
description BACKGROUND: Hypoxemia and fluctuations in respiratory mechanics parameters are common during one-lung ventilation (OLV) in thoracic surgery. Additionally, the incidence of postoperative pulmonary complications (PPC(S)) in thoracic surgery is higher than that in other surgeries. Previous studies have demonstrated that driving pressure-oriented ventilation can reduce both mortality in patients with acute respiratory distress syndrome (ARDS) and the incidence of PPC(S) in patients undergoing general anesthesia. Our aim was to determine whether driving pressure-oriented ventilation improves intraoperative physiology and outcomes in patients undergoing thoracic surgery. METHODS: We searched MEDLINE via PubMed, Embase, Cochrane, Web of Science, and ClinicalTrials.gov and performed a meta-analysis to compare the effects of driving pressure-oriented ventilation with other ventilation strategies on patients undergoing OLV. The primary outcome was the PaO(2)/FiO(2) ratio (P/F ratio) during OLV. The secondary outcomes were the incidence of PPC(S) during follow-up, compliance of the respiratory system during OLV, and mean arterial pressure during OLV. RESULTS: This review included seven studies, with a total of 640 patients. The PaO(2)/FiO(2) ratio was higher during OLV in the driving pressure-oriented ventilation group (mean difference [MD]: 44.96; 95% confidence interval [CI], 24.22–65.70.32; I(2): 58%; P < 0.0001). The incidence of PPC(S) was lower (OR: 0.58; 95% CI, 0.34–0.99; I(2): 0%; P = 0.04) and the compliance of the respiratory system was higher (MD: 6.15; 95% CI, 3.97–8.32; I(2): 57%; P < 0.00001) in the driving pressure-oriented group during OLV. We did not find a significant difference in the mean arterial pressure between the two groups. CONCLUSION: Driving pressure-oriented ventilation during OLV in patients undergoing thoracic surgery was associated with better perioperative oxygenation, fewer PPC(S), and improved compliance of the respiratory system. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, identifier: CRD42021297063.
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spelling pubmed-91986502022-06-16 Effect of Driving Pressure-Oriented Ventilation on Patients Undergoing One-Lung Ventilation During Thoracic Surgery: A Systematic Review and Meta-Analysis Li, Xuan Xue, Wenqiang Zhang, Qinyu Zhu, Yuyang Fang, Yu Huang, Jie Front Surg Surgery BACKGROUND: Hypoxemia and fluctuations in respiratory mechanics parameters are common during one-lung ventilation (OLV) in thoracic surgery. Additionally, the incidence of postoperative pulmonary complications (PPC(S)) in thoracic surgery is higher than that in other surgeries. Previous studies have demonstrated that driving pressure-oriented ventilation can reduce both mortality in patients with acute respiratory distress syndrome (ARDS) and the incidence of PPC(S) in patients undergoing general anesthesia. Our aim was to determine whether driving pressure-oriented ventilation improves intraoperative physiology and outcomes in patients undergoing thoracic surgery. METHODS: We searched MEDLINE via PubMed, Embase, Cochrane, Web of Science, and ClinicalTrials.gov and performed a meta-analysis to compare the effects of driving pressure-oriented ventilation with other ventilation strategies on patients undergoing OLV. The primary outcome was the PaO(2)/FiO(2) ratio (P/F ratio) during OLV. The secondary outcomes were the incidence of PPC(S) during follow-up, compliance of the respiratory system during OLV, and mean arterial pressure during OLV. RESULTS: This review included seven studies, with a total of 640 patients. The PaO(2)/FiO(2) ratio was higher during OLV in the driving pressure-oriented ventilation group (mean difference [MD]: 44.96; 95% confidence interval [CI], 24.22–65.70.32; I(2): 58%; P < 0.0001). The incidence of PPC(S) was lower (OR: 0.58; 95% CI, 0.34–0.99; I(2): 0%; P = 0.04) and the compliance of the respiratory system was higher (MD: 6.15; 95% CI, 3.97–8.32; I(2): 57%; P < 0.00001) in the driving pressure-oriented group during OLV. We did not find a significant difference in the mean arterial pressure between the two groups. CONCLUSION: Driving pressure-oriented ventilation during OLV in patients undergoing thoracic surgery was associated with better perioperative oxygenation, fewer PPC(S), and improved compliance of the respiratory system. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, identifier: CRD42021297063. Frontiers Media S.A. 2022-05-27 /pmc/articles/PMC9198650/ /pubmed/35722525 http://dx.doi.org/10.3389/fsurg.2022.914984 Text en Copyright © 2022 Li, Xue, Zhang, Zhu, Fang and Huang. 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) (https://creativecommons.org/licenses/by/4.0/) . 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 Surgery
Li, Xuan
Xue, Wenqiang
Zhang, Qinyu
Zhu, Yuyang
Fang, Yu
Huang, Jie
Effect of Driving Pressure-Oriented Ventilation on Patients Undergoing One-Lung Ventilation During Thoracic Surgery: A Systematic Review and Meta-Analysis
title Effect of Driving Pressure-Oriented Ventilation on Patients Undergoing One-Lung Ventilation During Thoracic Surgery: A Systematic Review and Meta-Analysis
title_full Effect of Driving Pressure-Oriented Ventilation on Patients Undergoing One-Lung Ventilation During Thoracic Surgery: A Systematic Review and Meta-Analysis
title_fullStr Effect of Driving Pressure-Oriented Ventilation on Patients Undergoing One-Lung Ventilation During Thoracic Surgery: A Systematic Review and Meta-Analysis
title_full_unstemmed Effect of Driving Pressure-Oriented Ventilation on Patients Undergoing One-Lung Ventilation During Thoracic Surgery: A Systematic Review and Meta-Analysis
title_short Effect of Driving Pressure-Oriented Ventilation on Patients Undergoing One-Lung Ventilation During Thoracic Surgery: A Systematic Review and Meta-Analysis
title_sort effect of driving pressure-oriented ventilation on patients undergoing one-lung ventilation during thoracic surgery: a systematic review and meta-analysis
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9198650/
https://www.ncbi.nlm.nih.gov/pubmed/35722525
http://dx.doi.org/10.3389/fsurg.2022.914984
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