Higher vs. lower positive end-expiratory pressure during one-lung ventilation for thoracic surgery: a systematic review and meta-analysis - Report - MDSpire
Advertisement
Higher vs. lower positive end-expiratory pressure during one-lung ventilation for thoracic surgery: a systematic review and meta-analysis
Clinical Report: Comparative Analysis of High and Low PEEP in OLV
Overview
Revise to clarify the relationship between higher PEEP and postoperative pulmonary complications.
Background
One-lung ventilation (OLV) is essential for thoracic surgeries, but it poses risks such as atelectasis and hemodynamic instability. Optimizing ventilation strategies, particularly the use of positive end-expiratory pressure (PEEP), is crucial for improving patient outcomes. Understanding the balance between oxygenation benefits and hemodynamic costs of PEEP is vital for perioperative care.
Data Highlights
Outcome
Higher PEEP
Lower PEEP
Risk Ratio (RR)
95% CI
Intraoperative Hypotension
Increased
—
2.16
1.29–3.63
Postoperative Pulmonary Complications
No significant reduction
—
0.95
0.88–1.02
New-Onset Arrhythmia
More frequent
—
2.56
1.76–3.71
Rescue Hypoxaemia Interventions
Less frequent
—
0.37
0.25–0.56
Pooled Vasopressor Use
No significant difference
—
1.05
0.97–1.13
Key Findings
Higher PEEP significantly increases the risk of intraoperative hypotension (RR: 2.16).
No significant reduction in postoperative pulmonary complications with higher PEEP (RR: 0.95).
New-onset arrhythmia is more frequent with higher PEEP (RR: 2.56).
Rescue hypoxaemia interventions are less frequent with higher PEEP (RR: 0.37).
Pooled vasopressor use does not differ significantly between higher and lower PEEP groups (RR: 1.05).
Clinical Implications
Clinicians should exercise caution when applying higher fixed PEEP during one-lung ventilation due to the associated risk of intraoperative hypotension. Individualized PEEP titration strategies may be more beneficial in balancing oxygenation and hemodynamic stability.
Conclusion
The findings indicate that while higher PEEP may offer some oxygenation benefits, the increased risk of hypotension and lack of reduction in pulmonary complications warrant a careful approach to its use in thoracic surgery.
