Gulfairus A Yessenbayeva, Aizhan M Meyerbekova, Sergey I Kim, Murat B Zhumabayev, Gulbanu S Berdiyarova, Sanzhar B Shalekenov, Dinara S Zharlyganova, Irina Y Mukatova, Yekaterina A Yukhnevich, Dmitriy A Klyuyev, Andrey I Yaroshetskiy
{"title":"正呼气末压对接受反Trendelenburg体位腹腔镜手术的肥胖患者氧合、呼吸顺应性和血流动力学的影响：随机对照试验的系统回顾和荟萃分析。","authors":"Gulfairus A Yessenbayeva, Aizhan M Meyerbekova, Sergey I Kim, Murat B Zhumabayev, Gulbanu S Berdiyarova, Sanzhar B Shalekenov, Dinara S Zharlyganova, Irina Y Mukatova, Yekaterina A Yukhnevich, Dmitriy A Klyuyev, Andrey I Yaroshetskiy","doi":"10.1186/s12871-025-02933-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>High and individual positive end-expiratory pressure (PEEP) during laparoscopic surgery may improve oxygenation and respiratory mechanics.</p><p><strong>Methods: </strong>We searched RCTs in PubMed, Cochrane Library, Web of Science, and Google Scholar from from from January 2000 to December 2023 comparing the different intraoperative PEEP (low PEEP (LPEEP): 0-5 mbar; moderate PEEP (MPEEP): 6-9 mbar; high PEEP (HPEEP): >=10 mbar; individualized PEEP (iPEEP): PEEP set by special physiological technique) on arterial oxygenation, respiratory compliance (Cdyn) or driving pressure, mean arterial pressure (MAP), and heart rate (HR) in patients during laparoscopic surgery in reverse Trendelenburg position. We calculated mean differences (MD) with 95% confidence intervals (CI), and predictive intervals (PI) using random-effects models. The Cochrane Bias Risk Assessment Tool was applied.</p><p><strong>Results: </strong>8 RCTs (n = 425) met the inclusion criteria. HPEEP vs. LPEEP increased PaO<sub>2</sub>/FiO<sub>2</sub> (+ 129.93 [+ 75.20; +184.65] mmHg, p < 0.0001) with high variation of true effect (Chi<sup>2</sup> 34.92, p < 0.0001; I<sup>2</sup> 89%). iPEEP vs. LPEEP also increased PaO<sub>2</sub>/FiO<sub>2</sub> + 130.23 [+ 57.18; +203.27] mmHg, p = 0.0005) with high variation of true effect (Chi<sup>2</sup> 26.95, p < 0.0001; I<sup>2</sup> 93%). HPEEP vs. LPEEP increased Cdyn (+ 15.06 [5.47; +24.65] ml/mbar, p = 0.002) with high variation of true effect (Chi<sup>2</sup> 93.16, p < 0.0001; I<sup>2</sup> 96%). iPEEP vs. LPEEP increased Cdyn (+ 22.46 [+ 8.56; +36.35] ml/mbar, p = 0.002) with high variability of the true effect (Chi<sup>2</sup> 53.92, p < 0.0001; I<sup>2</sup> 96%). HPEEP group had higher MAP as compared to LPEEP) + 4.36 [+ 0.36;+8.36], p = 0.03), variability of the true effect was nonsignificant. HR did nit differ between all comparisons.</p><p><strong>Conclusion: </strong>In patients with obesity undergoing surgery in the reverse Trendelenburg position HPEEP and iPEEP may improve oxygenation, decrease driving pressure, and increase dynamic compliance compared to LPEEP with high variation of true effect without relevant hemodynamic compromise. Data with MPEEP comparisons are inconclusive.</p><p><strong>Prospero registration: </strong>CRD42023488971; registered December 14, 2023.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"61"},"PeriodicalIF":2.3000,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803948/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of a positive end-expiratory pressure on oxygenation, respiratory compliance, and hemodynamics in obese patients undergoing laparoscopic surgery in reverse Trendelenburg position: a systematic review and meta-analysis of randomized controlled trials.\",\"authors\":\"Gulfairus A Yessenbayeva, Aizhan M Meyerbekova, Sergey I Kim, Murat B Zhumabayev, Gulbanu S Berdiyarova, Sanzhar B Shalekenov, Dinara S Zharlyganova, Irina Y Mukatova, Yekaterina A Yukhnevich, Dmitriy A Klyuyev, Andrey I Yaroshetskiy\",\"doi\":\"10.1186/s12871-025-02933-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>High and individual positive end-expiratory pressure (PEEP) during laparoscopic surgery may improve oxygenation and respiratory mechanics.</p><p><strong>Methods: </strong>We searched RCTs in PubMed, Cochrane Library, Web of Science, and Google Scholar from from from January 2000 to December 2023 comparing the different intraoperative PEEP (low PEEP (LPEEP): 0-5 mbar; moderate PEEP (MPEEP): 6-9 mbar; high PEEP (HPEEP): >=10 mbar; individualized PEEP (iPEEP): PEEP set by special physiological technique) on arterial oxygenation, respiratory compliance (Cdyn) or driving pressure, mean arterial pressure (MAP), and heart rate (HR) in patients during laparoscopic surgery in reverse Trendelenburg position. We calculated mean differences (MD) with 95% confidence intervals (CI), and predictive intervals (PI) using random-effects models. The Cochrane Bias Risk Assessment Tool was applied.</p><p><strong>Results: </strong>8 RCTs (n = 425) met the inclusion criteria. HPEEP vs. LPEEP increased PaO<sub>2</sub>/FiO<sub>2</sub> (+ 129.93 [+ 75.20; +184.65] mmHg, p < 0.0001) with high variation of true effect (Chi<sup>2</sup> 34.92, p < 0.0001; I<sup>2</sup> 89%). iPEEP vs. LPEEP also increased PaO<sub>2</sub>/FiO<sub>2</sub> + 130.23 [+ 57.18; +203.27] mmHg, p = 0.0005) with high variation of true effect (Chi<sup>2</sup> 26.95, p < 0.0001; I<sup>2</sup> 93%). HPEEP vs. LPEEP increased Cdyn (+ 15.06 [5.47; +24.65] ml/mbar, p = 0.002) with high variation of true effect (Chi<sup>2</sup> 93.16, p < 0.0001; I<sup>2</sup> 96%). iPEEP vs. LPEEP increased Cdyn (+ 22.46 [+ 8.56; +36.35] ml/mbar, p = 0.002) with high variability of the true effect (Chi<sup>2</sup> 53.92, p < 0.0001; I<sup>2</sup> 96%). HPEEP group had higher MAP as compared to LPEEP) + 4.36 [+ 0.36;+8.36], p = 0.03), variability of the true effect was nonsignificant. HR did nit differ between all comparisons.</p><p><strong>Conclusion: </strong>In patients with obesity undergoing surgery in the reverse Trendelenburg position HPEEP and iPEEP may improve oxygenation, decrease driving pressure, and increase dynamic compliance compared to LPEEP with high variation of true effect without relevant hemodynamic compromise. Data with MPEEP comparisons are inconclusive.</p><p><strong>Prospero registration: </strong>CRD42023488971; registered December 14, 2023.</p>\",\"PeriodicalId\":9190,\"journal\":{\"name\":\"BMC Anesthesiology\",\"volume\":\"25 1\",\"pages\":\"61\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2025-02-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803948/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMC Anesthesiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s12871-025-02933-2\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Anesthesiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12871-025-02933-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：腹腔镜手术中个体呼气末正压增高可能改善氧合和呼吸力学。方法：检索2000年1月至2023年12月PubMed、Cochrane Library、Web of Science和谷歌Scholar的随机对照试验，比较术中不同PEEP(低PEEP (LPEEP): 0-5 mbar；中等PEEP (MPEEP): 6- 9mbar；高PEEP (HPEEP): >=10 mbar；个体化正压（iPEEP）：通过特殊生理技术设置的正压（PEEP）对腹腔镜手术患者逆行Trendelenburg体位时动脉氧合、呼吸顺应性（Cdyn）或驱动压、平均动脉压（MAP）、心率（HR）的影响。我们使用随机效应模型计算95%置信区间（CI）的均值差（MD）和预测区间（PI）。采用Cochrane偏倚风险评估工具。结果：8项rct （n = 425）符合纳入标准。HPEEP比LPEEP增加PaO2/FiO2 (+ 129.93 [+ 75.20]；+184.65] mmHg, p 2.34.92, p 2.89%)。iPEEP与LPEEP均升高PaO2/FiO2 + 130.23 [+ 57.18]；[203.27] mmHg, p = 0.0005)，真实效果变化较大（ch2 26.95, p 2 93%）。HPEEP比LPEEP升高Cdyn (+ 15.06 [5.47]；+24.65] ml/mbar, p = 0.002)，真实效果变化较大（ch2 93.16, p = 2.96%）。iPEEP与LPEEP均升高Cdyn (+ 22.46 [+ 8.56]；+36.35] ml/mbar, p = 0.002)，真实效果变异性高（ch2 53.92, p 2 96%）。HPEEP组MAP高于LPEEP组（+ 4.36 [+ 0.36;+8.36],p = 0.03），真实效果的变异性不显著。在所有的比较中，人力资源没有差异。结论：肥胖患者逆行Trendelenburg体位手术时，与LPEEP相比，HPEEP和iPEEP可改善氧合，降低驱动压，增加动态顺应性，其真实效果变化大，且血流动力学不受损。与MPEEP比较的数据尚无定论。普洛斯彼罗注册：CRD42023488971；注册于2023年12月14日。
Impact of a positive end-expiratory pressure on oxygenation, respiratory compliance, and hemodynamics in obese patients undergoing laparoscopic surgery in reverse Trendelenburg position: a systematic review and meta-analysis of randomized controlled trials.
Background: High and individual positive end-expiratory pressure (PEEP) during laparoscopic surgery may improve oxygenation and respiratory mechanics.
Methods: We searched RCTs in PubMed, Cochrane Library, Web of Science, and Google Scholar from from from January 2000 to December 2023 comparing the different intraoperative PEEP (low PEEP (LPEEP): 0-5 mbar; moderate PEEP (MPEEP): 6-9 mbar; high PEEP (HPEEP): >=10 mbar; individualized PEEP (iPEEP): PEEP set by special physiological technique) on arterial oxygenation, respiratory compliance (Cdyn) or driving pressure, mean arterial pressure (MAP), and heart rate (HR) in patients during laparoscopic surgery in reverse Trendelenburg position. We calculated mean differences (MD) with 95% confidence intervals (CI), and predictive intervals (PI) using random-effects models. The Cochrane Bias Risk Assessment Tool was applied.
Results: 8 RCTs (n = 425) met the inclusion criteria. HPEEP vs. LPEEP increased PaO2/FiO2 (+ 129.93 [+ 75.20; +184.65] mmHg, p < 0.0001) with high variation of true effect (Chi2 34.92, p < 0.0001; I2 89%). iPEEP vs. LPEEP also increased PaO2/FiO2 + 130.23 [+ 57.18; +203.27] mmHg, p = 0.0005) with high variation of true effect (Chi2 26.95, p < 0.0001; I2 93%). HPEEP vs. LPEEP increased Cdyn (+ 15.06 [5.47; +24.65] ml/mbar, p = 0.002) with high variation of true effect (Chi2 93.16, p < 0.0001; I2 96%). iPEEP vs. LPEEP increased Cdyn (+ 22.46 [+ 8.56; +36.35] ml/mbar, p = 0.002) with high variability of the true effect (Chi2 53.92, p < 0.0001; I2 96%). HPEEP group had higher MAP as compared to LPEEP) + 4.36 [+ 0.36;+8.36], p = 0.03), variability of the true effect was nonsignificant. HR did nit differ between all comparisons.
Conclusion: In patients with obesity undergoing surgery in the reverse Trendelenburg position HPEEP and iPEEP may improve oxygenation, decrease driving pressure, and increase dynamic compliance compared to LPEEP with high variation of true effect without relevant hemodynamic compromise. Data with MPEEP comparisons are inconclusive.
Prospero registration: CRD42023488971; registered December 14, 2023.
期刊介绍：
BMC Anesthesiology is an open access, peer-reviewed journal that considers articles on all aspects of anesthesiology, critical care, perioperative care and pain management, including clinical and experimental research into anesthetic mechanisms, administration and efficacy, technology and monitoring, and associated economic issues.
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