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Weaning from mechanical ventilation in the operating room: a systematic review
Megan Abbott1, Sergio M Pereira2, Noah Sanders3
1Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada.
British Journal of Anaesthesia
|May 30, 2024
Summary
Weaning from intraoperative mechanical ventilation (MV) using pressure support ventilation (PSV), individualized positive end-expiratory pressure (PEEP), and low fraction of inspired oxygen (FiO2) may reduce postoperative pulmonary complications. Further research is needed due to low-quality evidence.
Area of Science:
- Anesthesiology and Critical Care Medicine
- Respiratory Physiology
Background:
- Postoperative pulmonary complications (PPCs) increase mortality and hospital stay.
- Intraoperative mechanical ventilation (MV) is a known risk factor for PPCs.
- Weaning strategies from intraoperative MV are understudied.
Purpose of the Study:
- To systematically evaluate weaning strategies from intraoperative MV.
- To assess the effects of these strategies on postoperative pulmonary outcomes.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials and observational studies.
- Included 14 RCTs with 1719 adult patients undergoing intraoperative MV.
- Assessed risk of bias (Cochrane RoB2) and quality of evidence (GRADE).
Main Results:
- Strategies combining pressure support ventilation (PSV), positive end-expiratory pressure (PEEP), and low fraction of inspired oxygen (FiO2) improved atelectasis, oxygenation, and lung volumes.
- Individualized PEEP with low FiO2 showed potential for reduced PPCs.
- Low FiO2 alone improved atelectasis and oxygenation.
- Fixed PEEP strategies did not improve outcomes.
Conclusions:
- Limited research exists on intraoperative MV weaning strategies.
- Low-quality evidence suggests PSV, individualized PEEP, and low FiO2 may reduce PPCs.
- Further high-quality studies are warranted.
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