Fulltext

Ventilation strategies in obese patients undergoing surgery: a quantitative systematic review and meta-analysis†

Aldenkortt, M. ; Lysakowski, C. ; Elia, N. ; Brochard, L. ; Tramèr, M. R.

In: British Journal of Anaesthesia, 2012, vol. 109, no. 4, p. 493-502

Ajouter à la liste personnelle
    Titre
    • Ventilation strategies in obese patients undergoing surgery: a quantitative systematic review and meta-analysis†
    Auteur
    • Aldenkortt, M.. Division of Anaesthesia and
    • Lysakowski, C.. Division of Anaesthesia and
    • Elia, N.. Division of Anaesthesia and
    • Brochard, L.. Department of Anaesthesia, Clinical Pharmacology and Intensive Care, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
    • Tramèr, M. R.. Division of Anaesthesia and
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • British Journal of Anaesthesia, 2012, vol. 109, no. 4, p. 493-502. Oxford University Press
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:295817
    Summary
    Background Pathophysiological changes due to obesity may complicate mechanical ventilation during general anaesthesia. The ideal ventilation strategy is expected to optimize gas exchange and pulmonary mechanics and to reduce the risk of respiratory complications. Methods Systematic search (databases, bibliographies, to March 2012, all languages) was performed for randomized trials testing intraoperative ventilation strategies in obese patients (BMI ≥30 kg m−2), and reporting on gas exchange, pulmonary mechanics, or pulmonary complications. Meta-analyses were performed when data from at least three studies or 100 patients could be combined. Results Thirteen studies (505 obese surgical patients) reported on a variety of ventilation strategies: pressure- or volume-controlled ventilation (PCV, VCV), various tidal volumes, and different PEEP or recruitment manoeuvres (RM), and combinations thereof. Definitions and reporting of endpoints were inconsistent. In five trials (182 patients), RM added to PEEP compared with PEEP alone improved intraoperative ratio [weighted mean difference (WMD), 16.2 kPa; 95% confidence interval (CI), 8.0-24.4] and increased respiratory system compliance (WMD, 14 ml cm H2O−1; 95% CI, 8-20). Arterial pressure remained unchanged. In four trials (100 patients) comparing PCV with VCV, there was no difference in ratio, tidal volume, or arterial pressure. Comparison of further ventilation strategies or combination of other outcomes was not feasible. Data on postoperative complications were seldom reported. Conclusions The ideal intraoperative ventilation strategy in obese patients remains obscure. There is some evidence that RM added to PEEP compared with PEEP alone improves intraoperative oxygenation and compliance without adverse effects. There is no evidence of any difference between PCV and VCV