The effect of lung recruitment maneuvers on post-operative pulmonary complications for patients undergoing general anesthesia: A meta-analysis

Abstract

Background Respiratory function would be impaired during general anesthesia period. Researchers devoted their energies to finding effective strategies for protecting respiratory function. Low tidal volume, positive end-expiratory pressure (PEEP), and lung recruitment maneuvers (LRMs) were recommended for patients under mechanical ventilation. However, based on the current evidence, there was no consensus on whether LRMs should be routinely used for anesthetized patients with healthy lungs, and the benefits of them remained to be determined. Materials and methods To evaluate the benefits of LRMs on patients undergoing surgery with general anesthesia, we searched relevant studies in PubMed, EMBASE, Ovid Medline and the Cochrane Library up to June 30, 2018. The primary outcome was postoperative pulmonary complications (PPCs). Results Twelve trials involving 2756 anesthetized patients were included. The results of our study showed a significant benefit of LRMs for reducing the incidence of PPCs (RR = 0.67; 95%CI, 0.49 to 0.90; P<0.05; Chi 2 = 32.94, p for heterogeneity = 0.0005, I 2 = 67%). After subgroup analyses, we found LRMs combining with lung protective ventilation strategy and sustained recruitment maneuvers were associated with reducing the occurrence of PPCs. The results also revealed that the use of LRMs improved PaO 2 /FiO 2 in non-obese patients, but with extremely high heterogeneity (I 2 = 95%). Conclusion According to the findings from contemporary meta-analysis, LRMs combining with lung protective ventilation strategy may have an association with decreasing in the incidence of PPCs and improvement of oxygenation on non-obese patients. However, the conclusions must be interpreted cautiously as the outcome may be influenced dramatically due to varied LRMs and ventilation patterns.

<p>Effects of an Alveolar Recruitment Maneuver During Lung Protective Ventilation on Postoperative Pulmonary Complications in Elderly Patients Undergoing Laparoscopy</p>

“…19 Meanwhile, a recent meta-analysis reported that ARM combining with LPV reduced the occurrence of PPCs and improved oxygenation in non-obese patients. 8 Although they did not conclude the ideal strategy as the variable techniques of ARM, they suggested that sustained inflation might be better than step-wise recruitment on the development of PPC. 8 We applied ARM immediately before and after pneumoperitoneum based on previous studies.…”

“…8 Although they did not conclude the ideal strategy as the variable techniques of ARM, they suggested that sustained inflation might be better than step-wise recruitment on the development of PPC. 8 We applied ARM immediately before and after pneumoperitoneum based on previous studies. 20,21 A previous clinical study that examined the effect of preemptive ARM only before pneumoperitoneum reported that preemptive ARM improved arterial oxygenation and AaDO 2 during the laparoscopic hysterectomy.…”

“…A recent meta-analysis of 12 trials involving a total of 2756 anesthetized patients reported that using an ARM in combination with LPV reduced the incidence of PPCs in non-obese patients. 8 Another study showed that the combination of an ARM and positive endexpiratory pressure (PEEP) significantly improved oxygenation and reduced atelectasis, but PEEP or an ARM alone did not improve these parameters in obese patients. 9 Despite the clinical importance of perioperative respiratory care in elderly patients, there is little literature examining the reduction of PPCs after laparoscopic surgery in elderly patients.…”

Comparative study of effects of intraoperative use of positive end-expiratory pressure, intermittent recruitment maneuver, and conventional ventilation on pulmonary functions during long-duration laparotomy

“…Combining with PEEP, there was no remarkable reduction in the incidence of PPC. [ 13 ] Alveolar recruitment is achieved broadly by two types – sustained inflation of the lungs for 5–30 sec to a predetermined peak inspiratory pressure of 30–40 cm of H 2 O or incrementally increasing PEEP in a stepwise manner. [ 14 ] In the meta-analysis, it was found that sustained inflation technique may be better than stepwise lung recruitment maneuver in preventing PPC.…”

Effect of sugammadex on postoperative pulmonary complications in patients with respiratory dysfunction after laparoscopic gastric or intestinal surgery: A retrospective study

“…Respiratory function is impaired during general anesthesia [1]. Respiratory complications are associated with longer hospitalization and increased nancial cost [2].…”