Preoperative Exercise Training to Prevent Postoperative Pulmonary Complications in Adults Undergoing Major Surgery: A Systematic Review and Meta-analysis with Trial Sequential Analysis

Abstract Background Abdominal cancer surgeries have a high incidence of postoperative complications. One strategy to prevent postoperative complications is preoperative exercise training. There are no systematic reviews that have compared the effects of preoperative exercise training programs of different length, frequency and duration on pre and postoperative clinical outcomes as well as on length of hospital stay (LOS) and in-hospital and late mortality in people with abdominal cancer. Methods Searches for randomised controlled trials (RCTs) of preoperative exercise training for people undergoing major surgery for abdominal cancer will be conducted in Pubmed, EMBASE, PEDro (Physiotherapy Evidence Database) and the Cochrane Library. There will be no restrictions on the language or date of publication in the search. The primary outcomes of the systematic review will be incidence of postoperative pulmonary complications as well as post-intervention and postoperative exercise capacity. The risk of bias of included RCTs will be assessed using the PEDro scale. The quality of evidence will be rated using the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). Subgroup analyzes will be conducted based on: intervention performed with or without supervision; types of exercises; and frequency and duration of the intervention. Discussion Our hypothesis is that preoperative exercise training will reduce the incidence of postoperative pulmonary complications in people undergoing major surgery for abdominal cancer by improving their preoperative exercise capacity. We will also explore the effects of the program on LOS and mortality. Systematic review registration: This systematic review protocol was registered with PROSPERO (Prospective International Register of Systematic Reviews) (number CRD42020199765).

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Intraoperative ventilation strategies to prevent postoperative pulmonary complications: Systematic review, meta-analysis, and trial sequential analysis

Best Practice & Research Clinical Anaesthesiology ◽

10.1016/j.bpa.2015.09.002 ◽

2015 ◽

Vol 29 (3) ◽

pp. 331-340 ◽

Cited By ~ 14

Author(s):

Ary Serpa Neto ◽

Marcus J. Schultz ◽

Marcelo Gama de Abreu

Keyword(s):

Systematic Review ◽

Sequential Analysis ◽

Meta Analysis ◽

Pulmonary Complications ◽

Trial Sequential Analysis ◽

Postoperative Pulmonary Complications ◽

Ventilation Strategies ◽

Intraoperative Ventilation

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Pressure-controlled ventilation-volume guaranteed (PCV-VG) for postoperative pulmonary complications: a protocol for a systematic review with meta-analysis and trial sequential analysis

10.21203/rs.3.rs-435510/v1 ◽

2021 ◽

Author(s):

Jianqiao Zheng ◽

Li Du ◽

Xiaoqian Deng ◽

Lu Zhang ◽

Jia Wang ◽

...

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Sequential Analysis ◽

Pulmonary Complications ◽

Trial Sequential Analysis ◽

Postoperative Pulmonary Complications ◽

Ventilation Mode ◽

Controlled Ventilation ◽

Pressure Controlled Ventilation ◽

Pressure Controlled

Abstract BackgroundMore than 300 million major surgical procedures are performed worldwide yearly. Above 30% of patients undergoing surgery with mechanical ventilation may experience postoperative pulmonary complications (PPCs). PPCs are the main cause of perioperative morbidity and mortality and it can be decreased by optimizing the mechanical ventilation. Pressure-controlled ventilation-volume guaranteed (PCV-VG) is a new ventilation mode, which combines the advantages of volume-controlled ventilation and pressure-controlled ventilation, might reduce PPCs. The efficacy of PCV-VG for PPCs has not yet been systematically reviewed. Hence, we will conduct a systematic review to evaluate the efficacy of PCV-VG for PPCs. The aim of this protocol is to investigate the benefits of PCV-VG versus conventional ventilation mode for PPCs.MethodsWe will search PubMed, Web of Science, Cochrane Library, Ovid medline, Embase, China National Knowledge Infrastructure, Chinese BioMedical Literature, Wanfang and VIP databases from their inception until May 2021, to identify randomised controlled studies using related keywords. Simultaneously, clinical registration tests and gray literature will also be retrieved. Studies published in English or Chinese will be considered. The primary outcome will be the incidence of PPCs, secondary outcomes will be intraoperative parameters of respiratory and hemodynamic function. Data synthesis/statistical analyses will be performed using the Review Manager software (version 5.4) and Stata (version 16). Heterogeneity will be assessed by the standard chi-square test and I2 statistic. Two authors will independently search, extract data from and assess the risk bias of included studies according the Cochrane risk of bias tool. Trial sequential analysis will be used to control the risks of random errors. Funnel plots and Egger’s regression test will be used to assess the publication bias. Certainty of the evidence will be assessed by modified Jadad Scale.DiscussionThis study will systematically and comprehensively search literature and integrate evidence on the efficacy of PCV-VG for PPCs. Our results will help clinical decision-making and support the development of clinical practice guidelines.

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