Effect of individualized positive end-expiratory pressure on postoperative pulmonary complication after thoracic surgery:Meta analysis
Objective To systematically evaluate and compare the effect of individualized positive end-expiratory pressure(PEEP)and fixed PEEP on postoperative pulmonary complication(PPC)in patients undergoing thoracic surgery.Methods Databas-es including PubMed,Cochrane Library,Embase,China National Knowledge Infrastructure,Wanfang Data,and VIP Information were searched for randomized controlled trial(RCT)comparing the use of individualized PEEP and fixed PEEP during thoracic surgery.The retrieval period was from the establishment of each database to December 2023.At least two researchers independently screened the lit-erature,extracted data,and assessed the quality according to the Cochrane Handbook.Meta-analysis was conducted using RevMan 5.4 software.Results A total of 13 RCT were included,involving 3 535 patients,with 1 775 in the individualized PEEP group and 1760 in fixed PEEP group.Compared with the fixed PEEP group,the incidence of PPC decreased in the individualized PEEP group[odds ratio(OR)0.38(95％confidence interval(CI)0.29,0.51),P＜0.001],intraoperative arterial oxygen partial pressure(PaO2)in-creased[standardized mean difference(SMD)0.27(95％CI 0.12,0.42),P＜0.001],intraoperative lung compliance increased[SMD 0.75(95％CI 0.67,0.82),P＜0.001],and driving pressure(DP)decreased[SMD-2.17(95％CI-2.42,-1.93),P＜0.001].There were no statis-tical differences between the two groups in intraoperative mean arterial pressure(MAP)and the length of postoperative hospitalization stay(P＞0.05).Conclusions Compared with fixed PEEP,the use of individualized PEEP during thoracic surgery can improve intra-operative oxygenation,enhance lung compliance,reduce DP,and lower the incidence of PPC.
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