Comparison of Volume-Guaranteed or -Targeted, Pressure-Controlled Ventilation with Volume-Controlled Ventilation during Elective Surgery: A Systematic Review and Meta-Analysis.
Comparison of Volume-Guaranteed or -Targeted, Pressure-Controlled Ventilation with Volume-Controlled Ventilation during Elective Surgery: A Systematic Review and Meta-Analysis.
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DOI：
10.3390/jcm10061276
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发表时间：
2021-03-19
影响因子：
3.9
通讯作者：
Mathes A
中科院分区：
文献类型：
--
作者：
Schick V;Dusse F;Eckardt R;Kerkhoff S;Commotio S;Hinkelbein J;Mathes A
对于全麻下围手术期机械通气，现代呼吸机旨在结合压力控制通风(PCV)和容量控制通风(VCV)的优点，通常被称为“容量保证”或“容量目标”压力控制通风(PCV-VG)。这项系统综述和荟萃分析测试了PCV-VG模式在改善成人全麻下择期手术患者的气道压力(P峰、P平台、P平均值)、动态顺应性(Cdyn)或动脉血气(PaO2、PaCO2)方面的益处的假设。用预定义的搜索策略搜索三个主要的医学电子数据库，并根据Cochrane Review方法对出版物进行系统评价。用逆方差方法检验连续变量的均值差异，计算出95%的可信区间(CI)。基于不同研究的干预效果并不相同的假设，我们选择了一个随机效应模型。异质性评价采用χ-2检验和I2统计量。以P峰、P平台、P均值、Cdyn、PaO2和PaCO2作为主要终点进行评估。在确定的725篇文章中，有17篇最终符合资格标准，总共招募了929名患者。与随机效应模型[随机效应模型；P峰：CI−3.26至−1.47；P<；0.001；I2=82%；P平台：−3.12至−0.12；P=0.03；I2=90%]相比，仰卧式双肺通气时，PCV-VG的P峰(15次)、P平台(9次)显著降低，Cdyn(9次随机效应模型)显著降低。对于单肺通气(8项研究)，与VCV相比，PCV-VG允许更低的PPeak和更高的PaO2。在特伦德伦堡位(5项研究)中，这种影响仅对P峰有显著意义。这一系统性综述和荟萃分析表明，在接受择期手术的成人中，容量靶向、压力控制的通气模式可能会改善双肺和单肺通气的气道动力学，并改善单肺通气的氧合。
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.
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影响因子：
3.6
作者：
Lee JM;Lee SK;Rhim CC;Seo KH;Han M;Kim SY;Park EY
通讯作者：
Park EY
影响因子：
4
作者：
Hozo SP;Djulbegovic B;Hozo I
通讯作者：
Hozo I
影响因子：
3.7
作者：
Moher D;Shamseer L;Clarke M;Ghersi D;Liberati A;Petticrew M;Shekelle P;Stewart LA;PRISMA-P Group
通讯作者：
PRISMA-P Group
影响因子：
3.9
作者：
Park, Jin Ha;Park, In Kyeong;Kim, Min-Soo
通讯作者：
Kim, Min-Soo
DOI：
10.4103/aer.aer_82_19
发表时间：
2019-04-01
期刊：
Anesthesia, essays and researches
影响因子：
--
作者：
Gad, Mona;Gaballa, Khaled;Nabil, Hanan
通讯作者：
Nabil, Hanan