Higher vs. lower positive end-expiratory pressure during one-lung ventilation for thoracic surgery: a systematic review and meta-analysis

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Higher fixed PEEP during one-lung ventilation significantly increases the risk of intraoperative hypotension without reducing postoperative pulmonary complications.
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The systematic review included eight RCTs with 2,747 patients, assessing the effects of higher vs. lower fixed PEEP during thoracic surgery.
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Higher PEEP was associated with a 2.16-fold increased risk of intraoperative hypotension, indicating moderate certainty in the findings.
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New-onset arrhythmia occurred more frequently with higher PEEP, while rescue hypoxaemia interventions were less frequent.
5

The study suggests caution in routinely applying higher fixed PEEP during OLV, advocating for future research on individualized PEEP titration strategies.

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