Table_3_v1_Effect of Driving Pressure-Oriented Ventilation on Patients Undergoing One-Lung Ventilation During Thoracic Surgery: A Systematic Review and Meta-Analysis.docx

BackgroundHypoxemia and fluctuations in respiratory mechanics parameters are common during one-lung ventilation (OLV) in thoracic surgery. Additionally, the incidence of postoperative pulmonary complications (PPCS) in thoracic surgery is higher than that in other surgeries. Previous studies have demonstrated that driving pressure-oriented ventilation can reduce both mortality in patients with acute respiratory distress syndrome (ARDS) and the incidence of PPCS in patients undergoing general anesthesia. Our aim was to determine whether driving pressure-oriented ventilation improves intraoperative physiology and outcomes in patients undergoing thoracic surgery.
MethodsWe searched MEDLINE via PubMed, Embase, Cochrane, Web of Science, and ClinicalTrials.gov and performed a meta-analysis to compare the effects of driving pressure-oriented ventilation with other ventilation strategies on patients undergoing OLV. The primary outcome was the PaO2/FiO2 ratio (P/F ratio) during OLV. The secondary outcomes were the incidence of PPCS during follow-up, compliance of the respiratory system during OLV, and mean arterial pressure during OLV.
ResultsThis review included seven studies, with a total of 640 patients. The PaO2/FiO2 ratio was higher during OLV in the driving pressure-oriented ventilation group (mean difference [MD]: 44.96; 95% confidence interval [CI], 24.22–65.70.32; I2: 58%; P < 0.0001). The incidence of PPCS was lower (OR: 0.58; 95% CI, 0.34–0.99; I2: 0%; P = 0.04) and the compliance of the respiratory system was higher (MD: 6.15; 95% CI, 3.97–8.32; I2: 57%; P < 0.00001) in the driving pressure-oriented group during OLV. We did not find a significant difference in the mean arterial pressure between the two groups.
ConclusionDriving pressure-oriented ventilation during OLV in patients undergoing thoracic surgery was associated with better perioperative oxygenation, fewer PPCS, and improved compliance of the respiratory system.
Systematic Review RegistrationPROSPERO, identifier: CRD42021297063.

背景 胸外科手术单肺通气（one-lung ventilation, OLV）期间，低氧血症与呼吸力学参数波动较为常见。此外，胸外科手术患者术后肺部并发症（postoperative pulmonary complications, PPCS）发生率高于其他手术患者。既往研究表明，驱动压导向通气（driving pressure-oriented ventilation）可降低急性呼吸窘迫综合征（acute respiratory distress syndrome, ARDS）患者的病死率，同时降低全身麻醉患者术后肺部并发症的发生率。本研究旨在明确驱动压导向通气是否可改善胸外科手术患者术中生理状态与临床结局。
方法 本研究通过PubMed检索MEDLINE数据库，同时检索Embase、Cochrane、Web of Science及ClinicalTrials.gov数据库，采用Meta分析比较驱动压导向通气与其他通气策略对接受单肺通气患者的影响。本研究的主要结局指标为单肺通气期间的动脉血氧分压/吸入氧浓度比值（PaO2/FiO2 ratio, P/F比值）；次要结局指标包括随访期间术后肺部并发症发生率、单肺通气期间呼吸系统顺应性，以及单肺通气期间平均动脉压。
结果 本系统评价共纳入7项研究，合计640例患者。驱动压导向通气组患者单肺通气期间的P/F比值更高（均数差[mean difference, MD]：44.96；95%置信区间[95% confidence interval, CI]：24.22~65.70；I²=58%；P<0.0001）。驱动压导向通气组患者单肺通气期间术后肺部并发症发生率更低（比值比[odds ratio, OR]：0.58；95%CI：0.34~0.99；I²=0%；P=0.04），呼吸系统顺应性更高（MD：6.15；95%CI：3.97~8.32；I²=57%；P<0.00001）。两组患者单肺通气期间的平均动脉压无显著差异。
结论 胸外科手术患者单肺通气期间采用驱动压导向通气，可改善围术期氧合状态、降低术后肺部并发症发生率，并提升呼吸系统顺应性。
系统评价注册 国际前瞻性系统评价注册库（PROSPERO），注册编号：CRD42021297063。