Effects of individualized positive end-expiratory pressure on intraoperative oxygenation and postoperative pulmonary complications in patients requiring pneumoperitoneum with Trendelenburg position: A systematic review and meta-analysis

Lingqi Gao; Bingyan Zhang; Jiazheng Qi; Xu Zhao; Xiaojie Yan; Bing Li; Jingjing Shen; Tingting Gu; Qiong Yu; Mengqiang Luo; Yingwei Wang

doi:10.1097/JS9.0000000000002041

Effects of individualized positive end-expiratory pressure on intraoperative oxygenation and postoperative pulmonary complications in patients requiring pneumoperitoneum with Trendelenburg position: A systematic review and meta-analysis

Int J Surg. 2024 Aug 22. doi: 10.1097/JS9.0000000000002041. Online ahead of print.

Authors

Lingqi Gao¹, Bingyan Zhang^{2

3}, Jiazheng Qi¹, Xu Zhao⁴, Xiaojie Yan¹, Bing Li¹, Jingjing Shen¹, Tingting Gu¹, Qiong Yu¹, Mengqiang Luo¹, Yingwei Wang¹

Affiliations

¹ Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China.
² Department of Infectious diseases, Huashan Hospital, Fudan University, Shanghai, China.
³ National Medical Centre for infectious diseases, China.
⁴ Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.

PMID: 39172728
DOI: 10.1097/JS9.0000000000002041

Abstract

Background: Whether individualized positive end-expiratory pressure (PEEP) improves intraoperative oxygenation and reduces postoperative pulmonary complications (PPCs) remains unclear. This systematic review and meta-analysis examined whether individualized PEEP is associated with improved intraoperative oxygenation and reduce PPCs for patients needing pneumoperitoneum with the Trendelenburg position during surgery.

Methods: Medline, Embase, the Cochrane Library, and www.clinicaltrials.gov were searched for randomized controlled trials evaluating the effects of individualized PEEP on intraoperative oxygenation and PPCs in patients who required Trendelenburg positioning with pneumoperitoneum. The primary outcome was the oxygenation (PaO2/FiO2) during the procedure. Secondary outcomes included PPCs, intraoperative respiratory mechanics (driving pressure, compliance), and vasopressor consumption. DerSimonian-Laird random effects models were used to calculate mean differences (MDs) and log risk ratios (log RRs) with 95% confidence intervals (CIs). The Cochrane Risk-of-Bias tool 2.0 was applied to assess the risk of bias in included studies. The protocol of this meta-analysis has been registered in PROSPERO.

Results: We included 14 studies (1121 patients) that employed different individualized PEEP strategies. Compared with control groups, individualized PEEP groups exhibited a significantly improved intraoperative PaO2/FiO2 (MD=56.52 mm Hg, 95% CI: [33.98, 79.06], P<0.001) and reduced incidence of PPCs (log RR=-0.50, 95% CI: [-0.84, -0.16], P=0.004). Individualized PEEP reduced driving pressure while improving respiratory compliance. Intraoperative vasopressor consumption was similar between both groups. The weighted mean PEEP in the individual PEEP groups was 13.2 [95% CI, 11.7, 14.6] cmH2O. No evidence indicated that one individualized PEEP strategy is superior to others.

Conclusions: Individualized PEEP seems to work positively for lung protection in the Trendelenburg position and pneumoperitoneum in patients undergoing general anesthesia.