Effect Of Lung Protective Ventilation On Postoperative Pulmonary Complications Among Patients Undergoing Surgery: A Meta-analysis

Objective:To systematically review the effect of intraoperative pulmonary protective ventilation strategies,including low tidal volume,moderate-to-high end-expiratory pressure(PEEP),and/or recruitment maneuver(RM),on postoperative pulmonary complications in patients with general anesthesia.Methods:Such databases as Medline database and Embase database were searched to identify randomized controlled trials(RCTs)about the effect of intraoperative pulmonary protective ventilation strategie on postoperative pulmonary complications published from inception to 2017.Two independent reviewers screened literature,extracted data,and assessed the methodological quality by the Cochrane Col-laboration's tool.Then meta-analysis was performed using Rev Man 5.3.The main outcome,including lung injury,pneumonia and atelectasis,are expressed as relative risk [RR] and 95%confidence interval [CI].Results: 11 RCT involving 968 patients were included.Compared with patients in the control group,those who received lung-protective ventilation had a decreased risk of lung injury(RR 0.36;95% CI 0.18 to 0.71;I2 = 0%)and Pneumonia(RR 0.38;95% CI0.22 to 0.67;I2 = 0%),and atelectasis(RR 0.54;95% CI 0.35 to 0.83;I2 = 18%).No significant differences were observed between two groups in lung compliance,oxygenation index and length of hospital stay.Conclusion: Intraoperative pulmonary protective ventilation strategy is related to the reduction of postoperative lung injury,pneumonia and atelectasis.Therefore,the implementation of intraoperative pulmonary protective ventilation may reduce the risk of postoperative pulmonary complications.