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Weaning from mechanical ventilation in the operating room: a systematic review.
Abbott, Megan; Pereira, Sergio M; Sanders, Noah; Girard, Martin; Sankar, Ashwin; Sklar, Michael C.
Afiliación
  • Abbott M; Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada.
  • Pereira SM; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
  • Sanders N; Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada.
  • Girard M; Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Division of Critical Care, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal Re
  • Sankar A; Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
  • Sklar MC; Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. Electronic address:
Br J Anaesth ; 133(2): 424-436, 2024 Aug.
Article en En | MEDLINE | ID: mdl-38816331
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. SYSTEMATIC REVIEW PROTOCOL PROSPERO (CRD42022379145).
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Quirófanos / Desconexión del Ventilador Límite: Humans Idioma: En Revista: Br J Anaesth Año: 2024 Tipo del documento: Article País de afiliación: Canadá

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Quirófanos / Desconexión del Ventilador Límite: Humans Idioma: En Revista: Br J Anaesth Año: 2024 Tipo del documento: Article País de afiliación: Canadá