Individualized PEEP titration by lung compliance during one-lung ventilation: a meta-analysis

作者：Wan‐Jie Gu, Fengzhi Zhao, Federico Piccioni, Rui Shi, Xiang Si, Shuo Chen, Maurizio Cecconi, Haiyan Yin · 发表于：Critical Care · 年份：2025 · DOI：10.1186/s13054-024-05237-y · 被引用次数：21 · 研究领域：Respiratory Support and Mechanisms、Nosocomial Infections in ICU、Airway Management and Intubation Techniques

Despite the physiological advantages of positive end-expiratory pressure (PEEP), its optimal utilization during one-lung ventilation (OLV) remains uncertain. We aimed to investigate whether individualized PEEP titration by lung compliance is associated with a reduced risk of postoperative pulmonary complications during OLV. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials until April 1, 2024, to identify published randomized controlled trials that compared individualized PEEP titration by lung compliance with fixed PEEP during OLV. The primary outcome was a composite of postoperative pulmonary complications. Secondary outcomes included clinical outcomes (pneumonia, atelectasis, ARDS, cardiovascular complications, mortality), respiratory mechanics, gas exchanges, and hemodynamic variables. Subgroup analyses were conducted for the primary outcome according to the PEEP titration method (dynamic compliance vs. driving pressure/static compliance, stepwise decremental vs. incremental strategy). Ten trials involving 3426 patients were included. Compared with fixed PEEP, individualized PEEP titration by lung compliance was associated with reduced risk of a composite of postoperative pulmonary complications (eight trials, 3351 patients, risk ratio [RR] 0.55, 95% CI 0.38–0.78). Subgroup analyses suggested the association was evident in the subgroup with titration by dynamic compliance rather than driving pressure/static compliance and in the subgroup w...