title: Intraoperative ventilatory strategies to prevent postoperative pulmonary complications: a meta-analysis.
abstract: OBJECTIVE
  It is uncertain whether patients undergoing short-lasting mechanical ventilation for surgery benefit from lung-protective intraoperative ventilatory settings including the use of lower tidal volumes, higher levels of positive end-expiratory pressure (PEEP) and/or recruitment maneuvers. We meta-analyzed trials testing the effect of lung-protective intraoperative ventilatory settings on the incidence of postoperative pulmonary complications.
  
  
  RESULTS
  Eight articles (1669 patients) were included. Meta-analysis showed a decrease in lung injury development [risk ratio (RR) 0.40; 95% confidence interval (CI) 0.22-0.70; I 0%; number needed to treat (NNT) 37], pulmonary infection (RR 0.64; 95% CI 0.43-0.97; I 0%; NNT 27) and atelectasis (RR 0.67; 95% CI 0.47-0.96; I 48%; NNT 31) in patients receiving intraoperative mechanical ventilation with lower tidal volumes. Meta-analysis also showed a decrease in lung injury development (RR 0.29; 95% CI 0.14-0.60; I 0%; NNT 29), pulmonary infection (RR 0.62; 95% CI 0.40-0.96; I 15%; NNT 33) and atelectasis (RR 0.61; 95% CI 0.41-0.91; I 0%; NNT 29) in patients ventilated with higher levels of PEEP, with or without recruitment maneuvers.
  
  
  CONCLUSIONS
  Lung-protective intraoperative ventilatory settings have the potential to protect against postoperative pulmonary complications.
authors: Departments of Intensive Care and Anesthesiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. s.hemmes@amc.uva.nl
authors: Sabrine N T
authors: SN
authors: Hemmes
authors: Ary
authors: A
authors: Serpa Neto
authors: Marcus J
authors: MJ
authors: Schultz
mesh_terms: D006801:Humans; D007432:Intraoperative Period; D008171:Lung Diseases / Q000517:prevention & control*; D011175:Positive-Pressure Respiration; D011183:Postoperative Complications / Q000517:prevention & control*; D012121:Respiration, Artificial