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个体化呼气末正压设置降低术后肺部并发症的发生率：一项系统综述和荟萃分析
贵州医科大学 麻醉与心脏电生理课题组
翻译：王婷婷 编辑：王婷婷 审校：曹莹
背景与目的：全身麻醉期间常发生进行性肺不张；因此，我们常使用呼气末正压（PEEP）。与固定PEEP设置相比，个体化PEEP滴定可能降低术后肺部并发症（PPCs）的发生率并改善氧合；然而，缺乏相关临床证据。
方法：该系统评价和meta分析在PROSPERO （CRD42021282228）注册。我们于2021年10月14日在4个数据库（MEDLINE Via PubMed、EMBASE、CENTRAL和Web of Science）中进行了系统检索，并于2024年4月26日更新。我们搜索并比较腹部手术中个体化滴定和固定PEEP策略效果的随机对照试验。主要终点为PPCs发生率。次要终点包括手术结束时的PaO2/FiO2、个体化设置的PEEP值、血管加压药需求和呼吸力学。
结果：共纳入30项研究（2602例患者）。个体化组患者PPCs发生率显著低于非个体化组（RR = 0.70, CI: 0.58 ~ 0.84）。手术结束时，个体化组PaO2/FiO2比值显著高于对照组（MD = 55.99 mmHg, 95% CI: 31.78 ~ 80.21）。个体PEEP显著高于常规设置（MD = 6.27 cm H2O, CI: 4.30 ~ 8.23）。对照组需要升压药物支持的患者较少；然而，这一结果并不显著。肺功能相关结果显示个体化组呼吸力学较好（Cstat: MD = 11.92 cm H2O, 95% CI: 6.40 ~ 17.45）。
结论：我们的结果表明，个体化滴定的PEEP可减少腹部手术患者的PPCs，并改善氧合。
原始文献来源：Szigetváry C, Szabó GV, Dembrovszky F, et al. Individualised Positive End-Expiratory Pressure Settings Reduce the Incidence of Postoperative Pulmonary Complications: A Systematic Review and Meta-Analysis. J Clin Med. 2024;13(22):6776. Published 2024 Nov 11. doi:10.3390/jcm13226776
Individualised Positive End-Expiratory Pressure Settings Reduce the Incidence of Postoperative Pulmonary Complications: A Systematic Review and Meta-Analysis
Background: Progressive atelectasis regularly occurs during general anaesthesia; hence, positive end-expiratory pressure (PEEP) is often applied. Individualised PEEP titration may reduce the incidence of postoperative pulmonary complications (PPCs) and improve oxygenation as compared to fixed PEEP settings; however, evidence is lacking.
Methods: This systematic review and meta-analysis was registered on PROSPERO (CRD42021282228). A systematic search in four databases (MEDLINE Via PubMed, EMBASE, CENTRAL, and Web of Science) was performed on 14 October 2021 and updated on 26 April 2024. We searched for randomised controlled trials comparing the effects of individually titrated versus fixed PEEP strategies during abdominal surgeries. The primary endpoint was the incidence of PPCs. The secondary endpoints included the PaO2/FiO2 at the end of surgery, individually set PEEP value, vasopressor requirements, and respiratory mechanics.
Results: We identified 30 trials (2602 patients). The incidence of PPCs was significantly lower among patients in the individualised group (RR = 0.70, CI: 0.58-0.84). A significantly higher PaO2/FiO2 ratio was found in the individualised group as compared to controls at the end of the surgery (MD = 55.99 mmHg, 95% CI: 31.78-80.21). Individual PEEP was significantly higher as compared to conventional settings (MD = 6.27 cm H2O, CI: 4.30-8.23). Fewer patients in the control group needed vasopressor support; however, this result was non-significant. Lung-function-related outcomes showed better respiratory mechanics in the individualised group (Cstat: MD = 11.92 cm H2O 95% CI: 6.40-17.45).
Conclusions: Our results show that individually titrated PEEP results in fewer PPCs and better oxygenation in patients undergoing abdominal surgery.
