Abstract：
BACKGROUND: Prior studies have reported inconsistent results regarding the association between driving pressure-guided ventilation and postoperative pulmonary complications (PPCs). We aimed to investigate whether driving pressure-guided ventilation is associated with a lower risk of PPCs.
METHODS: We systematically searched electronic databases for RCTs comparing driving pressure-guided ventilation with conventional protective ventilation in adult surgical patients. The primary outcome was a composite of PPCs. Secondary outcomes were pneumonia, atelectasis, and acute respiratory distress syndrome (ARDS). Meta-analysis and subgroup analysis were conducted to calculate risk ratios (RRs) with 95% confidence intervals (CI). Trial sequential analysis (TSA) was used to assess the conclusiveness of evidence.
RESULTS: Thirteen RCTs with 3401 subjects were included. Driving pressure-guided ventilation was associated with a lower risk of PPCs (RR 0.70, 95% CI 0.56-0.87, P=0.001), as indicated by TSA. Subgroup analysis (P for interaction=0.04) found that the association was observed in non-cardiothoracic surgery (nine RCTs, 1038 subjects, RR 0.61, 95% CI 0.48-0.77, P< 0.0001), with TSA suggesting sufficient evidence and conclusive result; however, it did not reach significance in cardiothoracic surgery (four RCTs, 2363 subjects, RR 0.86, 95% CI 0.67-1.10, P=0.23), with TSA indicating insufficient evidence and inconclusive result. Similarly, a lower risk of pneumonia was found in non-cardiothoracic surgery but not in cardiothoracic surgery (P for interaction=0.046). No significant differences were found in atelectasis and ARDS between the two ventilation strategies.
CONCLUSIONS: Driving pressure-guided ventilation was associated with a lower risk of postoperative pulmonary complications in non-cardiothoracic surgery but not in cardiothoracic surgery.
UNASSIGNED: INPLASY 202410068.
METHODS: We systematically searched electronic databases for RCTs comparing driving pressure-guided ventilation with conventional protective ventilation in adult surgical patients. The primary outcome was a composite of PPCs. Secondary outcomes were pneumonia, atelectasis, and acute respiratory distress syndrome (ARDS). Meta-analysis and subgroup analysis were conducted to calculate risk ratios (RRs) with 95% confidence intervals (CI). Trial sequential analysis (TSA) was used to assess the conclusiveness of evidence.
RESULTS: Thirteen RCTs with 3401 subjects were included. Driving pressure-guided ventilation was associated with a lower risk of PPCs (RR 0.70, 95% CI 0.56-0.87, P=0.001), as indicated by TSA. Subgroup analysis (P for interaction=0.04) found that the association was observed in non-cardiothoracic surgery (nine RCTs, 1038 subjects, RR 0.61, 95% CI 0.48-0.77, P< 0.0001), with TSA suggesting sufficient evidence and conclusive result; however, it did not reach significance in cardiothoracic surgery (four RCTs, 2363 subjects, RR 0.86, 95% CI 0.67-1.10, P=0.23), with TSA indicating insufficient evidence and inconclusive result. Similarly, a lower risk of pneumonia was found in non-cardiothoracic surgery but not in cardiothoracic surgery (P for interaction=0.046). No significant differences were found in atelectasis and ARDS between the two ventilation strategies.
CONCLUSIONS: Driving pressure-guided ventilation was associated with a lower risk of postoperative pulmonary complications in non-cardiothoracic surgery but not in cardiothoracic surgery.
UNASSIGNED: INPLASY 202410068.
摘要：
背景：先前的研究报道了关于驱动压力引导通气与术后肺部并发症（PPC）之间的相关性的不一致结果。我们旨在调查驱动压力引导通气是否与PPC的低风险相关。
方法：我们系统地在电子数据库中搜索RCTs，比较成年手术患者的驱动压力引导通气和常规保护性通气。主要结果是PPC的复合物。次要结果是肺炎，肺不张,和急性呼吸窘迫综合征（ARDS）。采用Meta分析和亚组分析计算95%置信区间(CI)的风险比(RR)。试验序贯分析(TSA)用于评估证据的结论性。
结果：纳入了13个RCTs，3401名受试者。驱动压力引导通气与PPC风险较低相关(RR0.70,95%CI0.56-0.87,P=0.001),如TSA所示。亚组分析（相互作用的P=0.04）发现，在非心胸外科手术中观察到了这种关联（9个随机对照试验，1038个科目,RR0.61，95%CI0.48-0.77，P<0.0001），运输安全管理局提出了充分的证据和确凿的结果；然而，它在心胸外科手术中没有达到意义(四个随机对照试验，2363个科目，RR0.86，95%CI0.67-1.10，P=0.23），TSA表明证据不足，结果不确定。同样，非心胸手术的肺炎风险较低,但心胸手术的肺炎风险较低(P=0.046).两种通气策略在肺不张和ARDS方面没有发现显着差异。
结论：在非心胸外科手术中，驱动压力引导通气与术后肺部并发症的风险较低相关，而在心胸外科手术中没有。
■插入202410068。
方法：我们系统地在电子数据库中搜索RCTs，比较成年手术患者的驱动压力引导通气和常规保护性通气。主要结果是PPC的复合物。次要结果是肺炎，肺不张,和急性呼吸窘迫综合征（ARDS）。采用Meta分析和亚组分析计算95%置信区间(CI)的风险比(RR)。试验序贯分析(TSA)用于评估证据的结论性。
结果：纳入了13个RCTs，3401名受试者。驱动压力引导通气与PPC风险较低相关(RR0.70,95%CI0.56-0.87,P=0.001),如TSA所示。亚组分析（相互作用的P=0.04）发现，在非心胸外科手术中观察到了这种关联（9个随机对照试验，1038个科目,RR0.61，95%CI0.48-0.77，P<0.0001），运输安全管理局提出了充分的证据和确凿的结果；然而，它在心胸外科手术中没有达到意义(四个随机对照试验，2363个科目，RR0.86，95%CI0.67-1.10，P=0.23），TSA表明证据不足，结果不确定。同样，非心胸手术的肺炎风险较低,但心胸手术的肺炎风险较低(P=0.046).两种通气策略在肺不张和ARDS方面没有发现显着差异。
结论：在非心胸外科手术中，驱动压力引导通气与术后肺部并发症的风险较低相关，而在心胸外科手术中没有。
■插入202410068。
