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Abstract：
BACKGROUND: This study compares the effect of positive end-expiratory pressure (PEEP) on postoperative pulmonary complications (PPCs) in patients with obesity undergoing laparoscopic bariatric surgery (LBS) under general anesthesia with mechanical ventilation.
METHODS: A comprehensive search was conducted in PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, China National Knowledge Internet, Wanfang database, and Google Scholar for studies published up to July 29, 2023, without time or language restrictions. The search terms included \"PEEP,\" \"laparoscopic,\" and \"bariatric surgery.\" Randomized controlled trials comparing different levels of PEEP or PEEP with zero-PEEP (ZEEP) in patients with obesity undergoing LBS were included. The primary outcome was a composite of PPCs, and the secondary outcomes were intraoperative oxygenation, respiratory compliance, and mean arterial pressure (MAP). A fixed-effect or random-effect model was selected for meta-analysis based on the heterogeneity of the included studies.
RESULTS: Thirteen randomized controlled trials with a total of 708 participants were included for analysis. No statistically significant difference in PPCs was found between the PEEP and ZEEP groups (risk ratio = 0.27, 95% CI: 0.05-1.60; p = 0.15). However, high PEEP ≥ 10 cm H2O significantly decreased PPCs compared with low PEEP < 10 cm H2O (risk ratio = 0.20, 95% CI: 0.05-0.89; p = 0.03). The included studies showed no significant heterogeneity (I2 = 20% & 0%). Compared with ZEEP, PEEP significantly increased intraoperative oxygenation and respiratory compliance (WMD = 74.97 mm Hg, 95% CI: 41.74-108.21; p < 0.001 & WMD = 9.40 ml cm H2O- 1, 95% CI: 0.65-18.16; p = 0.04). High PEEP significantly improved intraoperative oxygenation and respiratory compliance during pneumoperitoneum compared with low PEEP (WMD = 66.81 mm Hg, 95% CI: 25.85-107.78; p = 0.001 & WMD = 8.03 ml cm H2O- 1, 95% CI: 4.70-11.36; p < 0.001). Importantly, PEEP did not impair hemodynamic status in LBS.
CONCLUSIONS: In patients with obesity undergoing LBS, high PEEP ≥ 10 cm H2O could decrease PPCs compared with low PEEP < 10 cm H2O, while there was a similar incidence of PPCs between PEEP (8-10 cm H2O) and the ZEEP group. The application of PEEP in ventilation strategies increased intraoperative oxygenation and respiratory compliance without affecting intraoperative MAP. A PEEP of at least 10 cm H2O is recommended to reduce PPCs in patients with obesity undergoing LBS.
BACKGROUND: CRD42023391178 in PROSPERO.
METHODS: A comprehensive search was conducted in PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, China National Knowledge Internet, Wanfang database, and Google Scholar for studies published up to July 29, 2023, without time or language restrictions. The search terms included \"PEEP,\" \"laparoscopic,\" and \"bariatric surgery.\" Randomized controlled trials comparing different levels of PEEP or PEEP with zero-PEEP (ZEEP) in patients with obesity undergoing LBS were included. The primary outcome was a composite of PPCs, and the secondary outcomes were intraoperative oxygenation, respiratory compliance, and mean arterial pressure (MAP). A fixed-effect or random-effect model was selected for meta-analysis based on the heterogeneity of the included studies.
RESULTS: Thirteen randomized controlled trials with a total of 708 participants were included for analysis. No statistically significant difference in PPCs was found between the PEEP and ZEEP groups (risk ratio = 0.27, 95% CI: 0.05-1.60; p = 0.15). However, high PEEP ≥ 10 cm H2O significantly decreased PPCs compared with low PEEP < 10 cm H2O (risk ratio = 0.20, 95% CI: 0.05-0.89; p = 0.03). The included studies showed no significant heterogeneity (I2 = 20% & 0%). Compared with ZEEP, PEEP significantly increased intraoperative oxygenation and respiratory compliance (WMD = 74.97 mm Hg, 95% CI: 41.74-108.21; p < 0.001 & WMD = 9.40 ml cm H2O- 1, 95% CI: 0.65-18.16; p = 0.04). High PEEP significantly improved intraoperative oxygenation and respiratory compliance during pneumoperitoneum compared with low PEEP (WMD = 66.81 mm Hg, 95% CI: 25.85-107.78; p = 0.001 & WMD = 8.03 ml cm H2O- 1, 95% CI: 4.70-11.36; p < 0.001). Importantly, PEEP did not impair hemodynamic status in LBS.
CONCLUSIONS: In patients with obesity undergoing LBS, high PEEP ≥ 10 cm H2O could decrease PPCs compared with low PEEP < 10 cm H2O, while there was a similar incidence of PPCs between PEEP (8-10 cm H2O) and the ZEEP group. The application of PEEP in ventilation strategies increased intraoperative oxygenation and respiratory compliance without affecting intraoperative MAP. A PEEP of at least 10 cm H2O is recommended to reduce PPCs in patients with obesity undergoing LBS.
BACKGROUND: CRD42023391178 in PROSPERO.
摘要：
背景：这项研究比较了呼气末正压（PEEP）对在机械通气的全身麻醉下接受腹腔镜减肥手术（LBS）的肥胖患者术后肺部并发症（PPCs）的影响。
方法：在PubMed中进行了全面搜索，Embase,WebofScience,Cochrane中央控制试验登记册,中国全民知识互联网,万方数据库，以及截至2023年7月29日发表的谷歌学者研究，没有时间或语言限制。搜索词包括\"PEEP,腹腔镜，“和”减肥手术。纳入了随机对照试验，比较了接受LBS的肥胖患者不同水平的PEEP或PEEP与零PEEP（ZEEP）。主要结果是PPC的复合物，次要结局是术中氧合，呼吸顺应性,和平均动脉压（MAP）。根据纳入研究的异质性，选择固定效应或随机效应模型进行荟萃分析。
结果：共纳入了13项随机对照试验，共708名参与者用于分析。PEEP组和ZEEP组之间的PPC无统计学差异（风险比=0.27，95％CI：0.05-1.60；p=0.15）。然而,与低PEEP<10cmH2O相比,高PEEP≥10cmH2O显著降低PPCs(风险比=0.20,95%CI:0.05-0.89;p=0.03).纳入的研究没有显著的异质性(I2=20%&0%)。与ZEEP相比,PEEP显著增加术中氧合和呼吸顺应性（WMD=74.97mmHg，95%CI:41.74-108.21;p<0.001&WMD=9.40mlcmH2O-1,95%CI:0.65-18.16;p=0.04)。与低PEEP相比，高PEEP显着改善了气腹期间的术中氧合和呼吸顺应性（WMD=66.81mmHg，95%CI:25.85-107.78;p=0.001&WMD=8.03mlcmH2O-1,95%CI:4.70-11.36;p<0.001)。重要的是,PEEP并未损害LBS的血液动力学状态。
结论：在接受LBS的肥胖患者中，与低PEEP<10cmH2O相比，高PEEP≥10cmH2O可降低PPCs，而PEEP（8-10cmH2O）和ZEEP组之间的PPC发生率相似。PEEP在通气策略中的应用增加了术中氧合和呼吸顺应性，而不影响术中MAP。建议至少10cmH2O的PEEP减少患有LBS的肥胖患者的PPC。
背景：PROSPERO中的CRD42023391178。
方法：在PubMed中进行了全面搜索，Embase,WebofScience,Cochrane中央控制试验登记册,中国全民知识互联网,万方数据库，以及截至2023年7月29日发表的谷歌学者研究，没有时间或语言限制。搜索词包括\"PEEP,腹腔镜，“和”减肥手术。纳入了随机对照试验，比较了接受LBS的肥胖患者不同水平的PEEP或PEEP与零PEEP（ZEEP）。主要结果是PPC的复合物，次要结局是术中氧合，呼吸顺应性,和平均动脉压（MAP）。根据纳入研究的异质性，选择固定效应或随机效应模型进行荟萃分析。
结果：共纳入了13项随机对照试验，共708名参与者用于分析。PEEP组和ZEEP组之间的PPC无统计学差异（风险比=0.27，95％CI：0.05-1.60；p=0.15）。然而,与低PEEP<10cmH2O相比,高PEEP≥10cmH2O显著降低PPCs(风险比=0.20,95%CI:0.05-0.89;p=0.03).纳入的研究没有显著的异质性(I2=20%&0%)。与ZEEP相比,PEEP显著增加术中氧合和呼吸顺应性（WMD=74.97mmHg，95%CI:41.74-108.21;p<0.001&WMD=9.40mlcmH2O-1,95%CI:0.65-18.16;p=0.04)。与低PEEP相比，高PEEP显着改善了气腹期间的术中氧合和呼吸顺应性（WMD=66.81mmHg，95%CI:25.85-107.78;p=0.001&WMD=8.03mlcmH2O-1,95%CI:4.70-11.36;p<0.001)。重要的是,PEEP并未损害LBS的血液动力学状态。
结论：在接受LBS的肥胖患者中，与低PEEP<10cmH2O相比，高PEEP≥10cmH2O可降低PPCs，而PEEP（8-10cmH2O）和ZEEP组之间的PPC发生率相似。PEEP在通气策略中的应用增加了术中氧合和呼吸顺应性，而不影响术中MAP。建议至少10cmH2O的PEEP减少患有LBS的肥胖患者的PPC。
背景：PROSPERO中的CRD42023391178。
