Abstract：
The determination of optimal positive end-expiratory pressure (PEEP) values in patients undergoing general anesthesia remains controversial. Electrical impedance tomography (EIT) directed individualized PEEP has emerged as a novel approach to PEEP setting and has garnered increasing attention. This meta-analysis aims to systematically assess the effect of EIT-guided PEEP setting compared to traditional fixed PEEP values or other PEEP titration strategies in patients undergoing general anesthesia.
A comprehensive search of electronic databases, including PubMed, Web of Science, EMBASE, and the Cochrane Library, was conducted from inception to January 2023, with no language restrictions. The search terms used were \"EIT\"and \"PEEP\" with their corresponding free words. Two researchers independently conducted literature screening, data extraction, and quality evaluation. The primary outcomes of interest were oxygenation index (OI), lung compliance, and number of postoperative pulmonary complications (PPCs). The secondary outcomes included mean arterial blood pressure (MAP) and number of vasoactive drug injections. RevMan 5.3 software was used to analyze the data and draw the forest plot, and Stata 14.2 software was used to conduct sensitivity analysis to assess the stability of the results.
5 studies involving 272 participants were included in this meta-analysis. Our findings suggest that EIT-guided individualized PEEP setting is superior to traditional fixed PEEP values and other individualized PEEP titration methods in terms of intraoperative OI(OR = 95.73, 95%CI: (49.10, 142.37); P < 0.0001) and lung compliance(OR = 7.69, 95%CI: (5.55, 9.83); P < 0.00001), without affecting intraoperative hemodynamic parameters such as MAP(OR = 2.07, 95%CI: (-1.00, 5.13); P = 0.19) and the number of intravenous vasoactive drugs(OR = 1.22, 95%CI: (0.68, 2.21); P = 0.51) or increasing the incidence of postoperative PPCs(OR = 0.87, 95%CI: (0.41, 1.82); P = 0.71).
Our meta-analysis suggests potential benefits of EIT-guided individualized PEEP setting in improving intraoperative oxygenation and lung compliance in patients undergoing general anesthesia. However, further research is needed to establish conclusive evidence, and caution should be exercised in interpreting these findings as the current literature remains inconclusive regarding the impact on intraoperative hemodynamics and postoperative complications.
A comprehensive search of electronic databases, including PubMed, Web of Science, EMBASE, and the Cochrane Library, was conducted from inception to January 2023, with no language restrictions. The search terms used were \"EIT\"and \"PEEP\" with their corresponding free words. Two researchers independently conducted literature screening, data extraction, and quality evaluation. The primary outcomes of interest were oxygenation index (OI), lung compliance, and number of postoperative pulmonary complications (PPCs). The secondary outcomes included mean arterial blood pressure (MAP) and number of vasoactive drug injections. RevMan 5.3 software was used to analyze the data and draw the forest plot, and Stata 14.2 software was used to conduct sensitivity analysis to assess the stability of the results.
5 studies involving 272 participants were included in this meta-analysis. Our findings suggest that EIT-guided individualized PEEP setting is superior to traditional fixed PEEP values and other individualized PEEP titration methods in terms of intraoperative OI(OR = 95.73, 95%CI: (49.10, 142.37); P < 0.0001) and lung compliance(OR = 7.69, 95%CI: (5.55, 9.83); P < 0.00001), without affecting intraoperative hemodynamic parameters such as MAP(OR = 2.07, 95%CI: (-1.00, 5.13); P = 0.19) and the number of intravenous vasoactive drugs(OR = 1.22, 95%CI: (0.68, 2.21); P = 0.51) or increasing the incidence of postoperative PPCs(OR = 0.87, 95%CI: (0.41, 1.82); P = 0.71).
Our meta-analysis suggests potential benefits of EIT-guided individualized PEEP setting in improving intraoperative oxygenation and lung compliance in patients undergoing general anesthesia. However, further research is needed to establish conclusive evidence, and caution should be exercised in interpreting these findings as the current literature remains inconclusive regarding the impact on intraoperative hemodynamics and postoperative complications.
摘要：
背景：全身麻醉患者的最佳呼气末正压（PEEP）值的确定仍存在争议。针对个性化PEEP的电阻抗断层扫描（EIT）已成为PEEP设置的一种新颖方法，并引起了越来越多的关注。这项荟萃分析旨在系统地评估EIT指导的PEEP设置与传统固定PEEP值或其他PEEP滴定策略在全身麻醉患者中的效果。
方法：对电子数据库的全面搜索，包括PubMed,WebofScience,EMBASE,还有Cochrane图书馆,从成立到2023年1月，没有语言限制。使用的搜索词是\"EIT\"和\"PEEP\"及其相应的自由词。两名研究者独立进行文献筛选,数据提取,和质量评估。感兴趣的主要结果是氧合指数(OI)，肺顺应性,和术后肺部并发症（PPCs）的数量。次要结果包括平均动脉血压（MAP）和血管活性药物注射次数。采用RevMan5.3软件对数据进行分析，绘制森林地块，采用Stata14.2软件进行敏感性分析,评估结果的稳定性。
结果：本荟萃分析中纳入了5项涉及272名参与者的研究。我们的发现表明，在术中OI（OR=95.73，95CI：（49.10，142.37）;P<0.0001）和肺顺应性（OR=7.69，95CI：（5.55，9.83）;P<0.00001）方面，EIT指导的个性化PEEP设置优于传统的固定PEEP值和其他个性化PEEP滴定方法。不影响术中血流动力学参数，例如MAP（OR=2.07，95CI：（-1.00，5.13）；P=0.19）和静脉血管活性药物的数量（OR=1.22，95CI：（0.68，2.21）；P=0.51）或增加术后PPC的发生率（OR=0.87，95CI：（0.41，1.82）；P=0.71）。
结论：我们的荟萃分析提示EIT引导的个体化PEEP设置在改善全麻患者术中氧合和肺顺应性方面的潜在益处。然而,需要进一步的研究来建立确凿的证据，在解释这些发现时应谨慎行事,因为目前的文献尚不确定对术中血流动力学和术后并发症的影响.
方法：对电子数据库的全面搜索，包括PubMed,WebofScience,EMBASE,还有Cochrane图书馆,从成立到2023年1月，没有语言限制。使用的搜索词是\"EIT\"和\"PEEP\"及其相应的自由词。两名研究者独立进行文献筛选,数据提取,和质量评估。感兴趣的主要结果是氧合指数(OI)，肺顺应性,和术后肺部并发症（PPCs）的数量。次要结果包括平均动脉血压（MAP）和血管活性药物注射次数。采用RevMan5.3软件对数据进行分析，绘制森林地块，采用Stata14.2软件进行敏感性分析,评估结果的稳定性。
结果：本荟萃分析中纳入了5项涉及272名参与者的研究。我们的发现表明，在术中OI（OR=95.73，95CI：（49.10，142.37）;P<0.0001）和肺顺应性（OR=7.69，95CI：（5.55，9.83）;P<0.00001）方面，EIT指导的个性化PEEP设置优于传统的固定PEEP值和其他个性化PEEP滴定方法。不影响术中血流动力学参数，例如MAP（OR=2.07，95CI：（-1.00，5.13）；P=0.19）和静脉血管活性药物的数量（OR=1.22，95CI：（0.68，2.21）；P=0.51）或增加术后PPC的发生率（OR=0.87，95CI：（0.41，1.82）；P=0.71）。
结论：我们的荟萃分析提示EIT引导的个体化PEEP设置在改善全麻患者术中氧合和肺顺应性方面的潜在益处。然而,需要进一步的研究来建立确凿的证据，在解释这些发现时应谨慎行事,因为目前的文献尚不确定对术中血流动力学和术后并发症的影响.
