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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
PubMed
Abstract

Insights

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.
Keywords:
fraction of inspired oxygenmechanical ventilationpositive end-expiratory pressurepostoperative pulmonary complicationspostoperative pulmonary outcomespressure support ventilationweaning from mechanical ventilation

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