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Lung protective ventilation in patients undergoing major surgery: a systematic review incorporating a Bayesian approach.

Zhang Z, Hu X, Zhang X, Zhu X, Chen L, Zhu L, Hu C, Du B, China Critical Care Clinical Trials Group (CCCCT - BMJ Open (2015)

Bottom Line: PV had protective effect against the development of ALI as compared with the control group, with an OR of 0.41 (95% CI 0.19 to 0.87).Other adverse outcomes such as new onset arrhythmia were significantly reduced with the use of PV (OR 0.47, 95% CI 0.48 to 0.93).However, there is insufficient evidence that such a beneficial effect can be translated to more clinically relevant outcomes such as mortality or duration of MV.

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua, Zhejiang, People's Republic of China.

No MeSH data available.


Related in: MedlinePlus

Comparison of respiratory parameters between treatment and control groups. Protective ventilation induces higher oxygenation as compared with the control group (weighted mean difference (WMD) 17.79 mm Hg, 95% CI 7.99 to 27.60 mm Hg), but it results in more carbon dioxide retention (WMD 2.87, 95% 2.25 to 3.49 mm Hg). Alveolar-arterial oxygen gradient is not significantly different between groups. Finally, a lower pH value is found in the protective ventilation group (WMD −0.02, 95% −0.03 to −0.02 mm Hg), which is consistent with the carbon dioxide retention.
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BMJOPEN2014007473F4: Comparison of respiratory parameters between treatment and control groups. Protective ventilation induces higher oxygenation as compared with the control group (weighted mean difference (WMD) 17.79 mm Hg, 95% CI 7.99 to 27.60 mm Hg), but it results in more carbon dioxide retention (WMD 2.87, 95% 2.25 to 3.49 mm Hg). Alveolar-arterial oxygen gradient is not significantly different between groups. Finally, a lower pH value is found in the protective ventilation group (WMD −0.02, 95% −0.03 to −0.02 mm Hg), which is consistent with the carbon dioxide retention.

Mentions: Figure 3 shows the effect of PV on pulmonary and other adverse outcomes. The result showed that PV had a protective effect against the development of ALI as compared with the control group (27/507 vs 48/501), with an OR of 0.41 (95% CI 0.19 to 0.87). PV tended to be beneficial with regard to the development of pneumonia (14/400 vs 33/396; OR 0.46, 95% CI 0.16 to 1.28) and atelectasis (81/497 vs 101/492; OR 0.68, 95% CI 0.46 to 1.01), but statistical significance was not reached. Other adverse outcomes such as new onset arrhythmia were significantly reduced with the use of PV (82/473 vs 109/466; OR 0.47, 95% CI 0.48 to 0.93). Figure 4 shows the pooled effects of respiratory parameters. PV resulted in significantly increased oxygenation (WMD=17.79, 95% CI 7.99 to 27.60 mm Hg), but at the expense of carbon dioxide retention (WMD 2.87, 95% CI 2.25 to 3.49 mm Hg). Owing to significantly elevated PaCO2, arterial pH value was reduced in the PV group (WMD −0.02, 95% CI −0.03 to −0.02). However, the alveolar-arterial gradient was not significantly different between the two groups (WMD −20.39, 95% CI −45.32 to 4.55), most probably due to the limited number of studies being combined. With respect to other clinical outcomes, only the length of hospital stay could be marginally but statistically significantly shortened with the PV strategy (WMD −0.95, 95% CI −1.29 to −0.61 days). However, there was no evidence that PV could reduce the mortality, LOS in the ICU and the duration of MV (figure 5). A funnel plot was used to assess the publication bias. We arbitrarily selected two outcomes for this purpose (eg, ALI and PaCO2). The figure 6 shows some potential publication bias. Furthermore, Egger’s test showed p=0.006 for ALI and p=0.027 for PaCO2, both indicating significant bias.


Lung protective ventilation in patients undergoing major surgery: a systematic review incorporating a Bayesian approach.

Zhang Z, Hu X, Zhang X, Zhu X, Chen L, Zhu L, Hu C, Du B, China Critical Care Clinical Trials Group (CCCCT - BMJ Open (2015)

Comparison of respiratory parameters between treatment and control groups. Protective ventilation induces higher oxygenation as compared with the control group (weighted mean difference (WMD) 17.79 mm Hg, 95% CI 7.99 to 27.60 mm Hg), but it results in more carbon dioxide retention (WMD 2.87, 95% 2.25 to 3.49 mm Hg). Alveolar-arterial oxygen gradient is not significantly different between groups. Finally, a lower pH value is found in the protective ventilation group (WMD −0.02, 95% −0.03 to −0.02 mm Hg), which is consistent with the carbon dioxide retention.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4563268&req=5

BMJOPEN2014007473F4: Comparison of respiratory parameters between treatment and control groups. Protective ventilation induces higher oxygenation as compared with the control group (weighted mean difference (WMD) 17.79 mm Hg, 95% CI 7.99 to 27.60 mm Hg), but it results in more carbon dioxide retention (WMD 2.87, 95% 2.25 to 3.49 mm Hg). Alveolar-arterial oxygen gradient is not significantly different between groups. Finally, a lower pH value is found in the protective ventilation group (WMD −0.02, 95% −0.03 to −0.02 mm Hg), which is consistent with the carbon dioxide retention.
Mentions: Figure 3 shows the effect of PV on pulmonary and other adverse outcomes. The result showed that PV had a protective effect against the development of ALI as compared with the control group (27/507 vs 48/501), with an OR of 0.41 (95% CI 0.19 to 0.87). PV tended to be beneficial with regard to the development of pneumonia (14/400 vs 33/396; OR 0.46, 95% CI 0.16 to 1.28) and atelectasis (81/497 vs 101/492; OR 0.68, 95% CI 0.46 to 1.01), but statistical significance was not reached. Other adverse outcomes such as new onset arrhythmia were significantly reduced with the use of PV (82/473 vs 109/466; OR 0.47, 95% CI 0.48 to 0.93). Figure 4 shows the pooled effects of respiratory parameters. PV resulted in significantly increased oxygenation (WMD=17.79, 95% CI 7.99 to 27.60 mm Hg), but at the expense of carbon dioxide retention (WMD 2.87, 95% CI 2.25 to 3.49 mm Hg). Owing to significantly elevated PaCO2, arterial pH value was reduced in the PV group (WMD −0.02, 95% CI −0.03 to −0.02). However, the alveolar-arterial gradient was not significantly different between the two groups (WMD −20.39, 95% CI −45.32 to 4.55), most probably due to the limited number of studies being combined. With respect to other clinical outcomes, only the length of hospital stay could be marginally but statistically significantly shortened with the PV strategy (WMD −0.95, 95% CI −1.29 to −0.61 days). However, there was no evidence that PV could reduce the mortality, LOS in the ICU and the duration of MV (figure 5). A funnel plot was used to assess the publication bias. We arbitrarily selected two outcomes for this purpose (eg, ALI and PaCO2). The figure 6 shows some potential publication bias. Furthermore, Egger’s test showed p=0.006 for ALI and p=0.027 for PaCO2, both indicating significant bias.

Bottom Line: PV had protective effect against the development of ALI as compared with the control group, with an OR of 0.41 (95% CI 0.19 to 0.87).Other adverse outcomes such as new onset arrhythmia were significantly reduced with the use of PV (OR 0.47, 95% CI 0.48 to 0.93).However, there is insufficient evidence that such a beneficial effect can be translated to more clinically relevant outcomes such as mortality or duration of MV.

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua, Zhejiang, People's Republic of China.

No MeSH data available.


Related in: MedlinePlus