PDF(Pubmed)
Abstract：
BACKGROUND: Postoperative pulmonary complications (PPCs) are associated with postoperative mortality and prolonged hospital stay. Although intraoperative mechanical ventilation (MV) is a risk factor for PPCs, strategies addressing weaning from MV are understudied. In this systematic review, we evaluated weaning strategies and their effects on postoperative pulmonary outcomes.
METHODS: Our protocol was registered on PROSPERO (CRD42022379145). Eligible studies included randomised controlled trials and observational studies of adults weaned from MV in the operating room. Primary outcomes included atelectasis and oxygenation; secondary outcomes included lung volume changes and PPCs. Risk of bias was assessed using the Cochrane Risk of Bias (RoB2) tool, and quality of evidence with the GRADE framework.
RESULTS: Screening identified 14 randomised controlled trials including 1719 patients; seven studies were limited to the weaning phase and seven included interventions not restricted to the weaning phase. Strategies combining pressure support ventilation (PSV) with positive end-expiratory pressure (PEEP) and low fraction of inspired oxygen (FiO2) improved atelectasis, oxygenation, and lung volumes. Low FiO2 improved atelectasis and oxygenation but might not improve lung volumes. A fixed-PEEP strategy led to no improvement in oxygenation or atelectasis; however, individualised PEEP with low FiO2 improved oxygenation and might be associated with reduced PPCs. Half of included studies are of moderate or high risk of bias; the overall quality of evidence is low.
CONCLUSIONS: There is limited research evaluating weaning from intraoperative MV. Based on low-quality evidence, PSV, individualised PEEP, and low FiO2 may be associated with reduced postoperative pulmonary outcomes.
UNASSIGNED: PROSPERO (CRD42022379145).
METHODS: Our protocol was registered on PROSPERO (CRD42022379145). Eligible studies included randomised controlled trials and observational studies of adults weaned from MV in the operating room. Primary outcomes included atelectasis and oxygenation; secondary outcomes included lung volume changes and PPCs. Risk of bias was assessed using the Cochrane Risk of Bias (RoB2) tool, and quality of evidence with the GRADE framework.
RESULTS: Screening identified 14 randomised controlled trials including 1719 patients; seven studies were limited to the weaning phase and seven included interventions not restricted to the weaning phase. Strategies combining pressure support ventilation (PSV) with positive end-expiratory pressure (PEEP) and low fraction of inspired oxygen (FiO2) improved atelectasis, oxygenation, and lung volumes. Low FiO2 improved atelectasis and oxygenation but might not improve lung volumes. A fixed-PEEP strategy led to no improvement in oxygenation or atelectasis; however, individualised PEEP with low FiO2 improved oxygenation and might be associated with reduced PPCs. Half of included studies are of moderate or high risk of bias; the overall quality of evidence is low.
CONCLUSIONS: There is limited research evaluating weaning from intraoperative MV. Based on low-quality evidence, PSV, individualised PEEP, and low FiO2 may be associated with reduced postoperative pulmonary outcomes.
UNASSIGNED: PROSPERO (CRD42022379145).
摘要：
背景：术后肺部并发症（PPCs）与术后死亡率和住院时间延长有关。尽管术中机械通气（MV）是PPC的危险因素，解决从MV断奶的策略研究不足。在这次系统审查中，我们评估了撤机策略及其对术后肺部结局的影响.
方法：我们的方案在PROSPERO（CRD42022379145）上注册。符合条件的研究包括随机对照试验和对手术室中脱离MV的成年人的观察性研究。主要结果包括肺不张和氧合；次要结果包括肺容积变化和PPC。使用Cochrane偏差风险(RoB2)工具评估偏差风险，以及使用等级框架的证据质量。
结果：筛查确定了14项随机对照试验，包括1719例患者；7项研究仅限于断奶期，7项研究包括不限于断奶期的干预措施。将压力支持通气（PSV）与呼气末正压（PEEP）和低吸入氧气（FiO2）相结合的策略可改善肺不张，氧合，和肺容量。低FiO2改善了肺不张和氧合，但可能无法改善肺容量。固定PEEP策略没有改善氧合或肺不张；然而，低FiO2的个性化PEEP可改善氧合，并可能与PPC减少有关。一半的纳入研究存在中度或高度偏倚风险；总体证据质量较低。
结论：评估术中MV断奶的研究有限。基于低质量的证据,PSV,个性化PEEP，低FiO2可能与术后肺部结局降低有关。
■PROSPERO（CRD42022379145）。
方法：我们的方案在PROSPERO（CRD42022379145）上注册。符合条件的研究包括随机对照试验和对手术室中脱离MV的成年人的观察性研究。主要结果包括肺不张和氧合；次要结果包括肺容积变化和PPC。使用Cochrane偏差风险(RoB2)工具评估偏差风险，以及使用等级框架的证据质量。
结果：筛查确定了14项随机对照试验，包括1719例患者；7项研究仅限于断奶期，7项研究包括不限于断奶期的干预措施。将压力支持通气（PSV）与呼气末正压（PEEP）和低吸入氧气（FiO2）相结合的策略可改善肺不张，氧合，和肺容量。低FiO2改善了肺不张和氧合，但可能无法改善肺容量。固定PEEP策略没有改善氧合或肺不张；然而，低FiO2的个性化PEEP可改善氧合，并可能与PPC减少有关。一半的纳入研究存在中度或高度偏倚风险；总体证据质量较低。
结论：评估术中MV断奶的研究有限。基于低质量的证据,PSV,个性化PEEP，低FiO2可能与术后肺部结局降低有关。
■PROSPERO（CRD42022379145）。
