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Impact of pharmacological interventions on intrapulmonary shunt during one-lung ventilation in adult thoracic surgery: a systematic review and component network meta-analysis.
Schorer, Raoul; Dombret, Anna-Luna; Hagerman, Andres; Bédat, Benoît; Putzu, Alessandro.
Affiliation
  • Schorer R; Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland. Electronic address: raoul.schorer@hcuge.ch.
  • Dombret AL; Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland.
  • Hagerman A; Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland.
  • Bédat B; Division of Thoracic and Endocrine Surgery, Geneva University Hospitals, Geneva, Switzerland.
  • Putzu A; Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland.
Br J Anaesth ; 130(1): e92-e105, 2023 01.
Article in En | MEDLINE | ID: mdl-36939497
BACKGROUND: Intrapulmonary shunt is a major determinant of oxygenation in thoracic surgery under one-lung ventilation. We reviewed the effects of available treatments on shunt, Pao2/FiO2 and haemodynamics through systematic review and network meta-analysis. METHODS: Online databases were searched for RCTs comparing pharmacological interventions and intrapulmonary shunt in thoracic surgery under one-lung ventilation up to March 30, 2022. Random-effects (component) network meta-analysis compared 24 treatments and 19 treatment components. The Confidence in Network Meta-Analysis (CINeMA) framework assessed evidence certainty. The primary outcome was intrapulmonary shunt fraction during one-lung ventilation. RESULTS: A total of 55 RCTs were eligible for systematic review (2788 participants). The addition of N2O (mean difference [MD]=-15%; 95% confidence interval [CI], -25 to -5; P=0.003) or almitrine (MD=-13%; 95% CI, -20 to -6; P<0.001) to propofol anaesthesia were efficient at decreasing shunt. Combined epidural anaesthesia (MD=3%; 95% CI, 1-5; P=0.005), sevoflurane (MD=5%; 95% CI, 2-8; P<0.001), isoflurane (MD=6%; 95% CI, 4-9; P<0.001), and desflurane (MD=9%; 95% CI, 4-14; P=0.001) increased shunt vs propofol. Almitrine (MD=147 mm Hg; 95% CI, 58-236; P=0.001), dopexamine (MD=88 mm Hg; 95% CI, 4-171; P=0.039), and iloprost (MD=81 mm Hg; 95% CI, 4-158; P=0.038) improved Pao2/FiO2. Certainty of evidence ranged from very low to moderate. CONCLUSIONS: Adding N2O or almitrine to propofol anaesthesia reduced intrapulmonary shunt during one-lung ventilation. Halogenated anaesthetics increased shunt in comparison with propofol. The effects of N2O, iloprost, and dexmedetomidine should be investigated in future research. N2O results constitute a research hypothesis currently not backed by any direct evidence. The clinical availability of almitrine is limited. SYSTEMATIC REVIEW PROTOCOL: PROSPERO CRD42022310313.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Thoracic Surgery / Propofol / One-Lung Ventilation Type of study: Guideline / Systematic_reviews Limits: Adult / Humans Language: En Journal: Br J Anaesth Year: 2023 Document type: Article Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Thoracic Surgery / Propofol / One-Lung Ventilation Type of study: Guideline / Systematic_reviews Limits: Adult / Humans Language: En Journal: Br J Anaesth Year: 2023 Document type: Article Country of publication: