scholarly journals Dexmedetomidine attenuates one‐lung ventilation associated lung injury by suppressing inflammatory responses: a systematic review and meta‐analysis

2021 ◽  
Author(s):  
Yun‐Xiao Bai ◽  
Jie‐Han Zhang ◽  
Bing‐Cheng Zhao ◽  
Ke‐Xuan Liu ◽  
Yao‐Wu Bai
Keyword(s):  
Systematic Review ◽  
Lung Injury ◽  
Inflammatory Responses ◽  
Meta Analysis ◽  
Lung Ventilation ◽  
One Lung Ventilation

scholarly journals Comparison of Volume-Guaranteed or -Targeted, Pressure-Controlled Ventilation with Volume-Controlled Ventilation during Elective Surgery: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (6) ◽  
pp. 1276
Author(s):  
Volker Schick ◽  
Fabian Dusse ◽  
Ronny Eckardt ◽  
Steffen Kerkhoff ◽  
Simone Commotio ◽  
...  
Keyword(s):  
Systematic Review ◽  
Elective Surgery ◽  
Meta Analysis ◽  
Lung Ventilation ◽  
One Lung Ventilation ◽  
Controlled Ventilation ◽  
Pressure Controlled Ventilation ◽  
Volume Controlled Ventilation ◽  
Volume Controlled ◽  
Pressure Controlled

For perioperative mechanical ventilation under general anesthesia, modern respirators aim at combining the benefits of pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) in modes typically named “volume-guaranteed” or “volume-targeted” pressure-controlled ventilation (PCV-VG). This systematic review and meta-analysis tested the hypothesis that PCV-VG modes of ventilation could be beneficial in terms of improved airway pressures (Ppeak, Pplateau, Pmean), dynamic compliance (Cdyn), or arterial blood gases (PaO2, PaCO2) in adults undergoing elective surgery under general anesthesia. Three major medical electronic databases were searched with predefined search strategies and publications were systematically evaluated according to the Cochrane Review Methods. Continuous variables were tested for mean differences using the inverse variance method and 95% confidence intervals (CI) were calculated. Based on the assumption that intervention effects across studies were not identical, a random effects model was chosen. Assessment for heterogeneity was performed with the χ2 test and the I2 statistic. As primary endpoints, Ppeak, Pplateau, Pmean, Cdyn, PaO2, and PaCO2 were evaluated. Of the 725 publications identified, 17 finally met eligibility criteria, with a total of 929 patients recruited. Under supine two-lung ventilation, PCV-VG resulted in significantly reduced Ppeak (15 studies) and Pplateau (9 studies) as well as higher Cdyn (9 studies), compared with VCV [random effects models; Ppeak: CI −3.26 to −1.47; p < 0.001; I2 = 82%; Pplateau: −3.12 to −0.12; p = 0.03; I2 = 90%; Cdyn: CI 3.42 to 8.65; p < 0.001; I2 = 90%]. For one-lung ventilation (8 studies), PCV-VG allowed for significantly lower Ppeak and higher PaO2 compared with VCV. In Trendelenburg position (5 studies), this effect was significant for Ppeak only. This systematic review and meta-analysis demonstrates that volume-targeting, pressure-controlled ventilation modes may provide benefits with respect to the improved airway dynamics in two- and one-lung ventilation, and improved oxygenation in one-lung ventilation in adults undergoing elective surgery.

Tidal volume during one-lung ventilation: A systematic review and meta-analysis

2020 ◽  
Author(s):  
John K. Peel ◽  
Duane J. Funk ◽  
Peter Slinger ◽  
Sadeesh Srinathan ◽  
Biniam Kidane
Keyword(s):  
Systematic Review ◽  
Tidal Volume ◽  
Meta Analysis ◽  
Lung Ventilation ◽  
One Lung Ventilation

scholarly journals Effects of Tidal Volume on Physiology and Clinical Outcomes of Surgery Patients Undergoing One-lung Ventilation: A Meta-analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Feiping Xia ◽  
Zhonghua Lu ◽  
Yuying Tang ◽  
Haibo Qiu ◽  
Yi Yang ◽  
...  
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Lung Ventilation ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Controlled Trials ◽  
One Lung Ventilation ◽  
Randomized Controlled

Abstract Objective: It is unclear how tidal volume (Vt) impacts patients during one-lung ventilation (OLV). A meta-analysis was performed to assess the effect of Vt on physiology and clinical outcomes in OLV patients. Methods: PubMed, Cochrane library, and Web of Science were retrieved until February 2020. Randomized controlled trials comparing the application of low and high Vt ventilation in adults with OLV were included. Demographic variables, Vt, physiology, and clinical outcomes were retrieved. Summary odds ratios (ORs) with 95% confidence intervals (CIs) and mean difference with standard deviation were calculated using a random-effects model.Results: 12 studies involving a total of 876 participants met inclusion criteria. Significant difference in blood interleukin-6 (IL-6) was observed between low Vt ventilation and high Vt ventilation (MD -35.51 pg/ml, 95% CI [-66.47, -4.54 pg/ml], p = 0.02). Low Vt ventilation decreased driving pressure (ΔP) (MD -6.02 cmH2O, 95% CI [-8.32, -3.72 cmH2O], p < 0.0001), Peak pressure (Ppeak) (MD -2.88 cmH2O, 95% CI [-4.60, -1.16 cmH2O], p = 0.001), and improved PaO2/FiO2 (MD 32.27 mmHg, 95% CI [19.54, 45.01 mmHg], p <0.00001). Risk of atelectasis was the same between the two groups. Furthermore, the study suggested that low Vt ventilation was associated with decreases in the risk of acute lung injury (OR 0.05, 95% CI [0.28, 0.88], p = 0.02). Decreased hospital length of stay in the low Vt group occurred when Vt was set 4-5 ml/kg (MD -0.78 d, 95% CI [-1.45, -0.11 d], p = 0.02).Conclusions: In OLV patients, low Vt ventilation improved PaO2/FiO2, and it was also associated with decreased blood IL-6, ΔP, Ppeak, and risk of acute lung injury, when the low Vt was set 4-5 ml/kg hospital length of stay was decreased .

Sign in / Sign up

Export Citation Format

Share Document