Effect of intraoperative PEEP with recruitment maneuvers on the occurrence of postoperative pulmonary complications during general anesthesia––protocol for Bayesian analysis of three randomized clinical trials of intraoperative ventilation

Research output: Contribution to journalResearch articleContributedpeer-review


  • Guido Mazzinari - , University of Valencia, Hospital Universitario La Fe (Author)
  • Fernando G. Zampieri - , Hospital Israelita Albert Einstein (Author)
  • Lorenzo Ball - , University of Genoa (Author)
  • Niklas S. Campos - , Hospital Israelita Albert Einstein, Universidade de São Paulo (Author)
  • Thomas Bluth - , Department of Anesthesiology and Intensive Care Medicine (Author)
  • Sabrine N.T. Hemmes - , University of Amsterdam (Author)
  • Carlos Ferrando - , University of Barcelona, CIBER - Center for Biomedical Research Network (Author)
  • Julian Librero - , Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Author)
  • Marina Soro - , University of Valencia (Author)
  • Paolo Pelosi - , University of Genoa (Author)
  • Marcelo Gama de Abreu - , Department of Anesthesiology and Intensive Care Medicine (Author)
  • Marcus J. Schultz - , University of Amsterdam, University of Oxford, Mahidol Oxford Tropical Medicine Research Unit (MORU) (Author)
  • Ary Serpa Neto - , Hospital Israelita Albert Einstein, Universidade de São Paulo, University of Amsterdam, Monash University, University of Melbourne (Author)


Background: Using the frequentist approach, a recent meta–analysis of three randomized clinical trials in patients undergoing intraoperative ventilation during general anesthesia for major surgery failed to show the benefit of ventilation that uses high positive end–expiratory pressure with recruitment maneuvers when compared to ventilation that uses low positive end–expiratory pressure without recruitment maneuvers. Methods: We designed a protocol for a Bayesian analysis using the pooled dataset. The multilevel Bayesian logistic model will use the individual patient data. Prior distributions will be prespecified to represent a varying level of skepticism for the effect estimate. The primary endpoint will be a composite of postoperative pulmonary complications (PPC) within the first seven postoperative days, which reflects the primary endpoint of the original studies. We preset a range of practical equivalence to assess the futility of the intervention with an interval of odds ratio (OR) between 0.9 and 1.1 and assess how much of the 95% of highest density interval (HDI) falls between the region of practical equivalence. Ethics and dissemination: The used data derive from approved studies that were published in recent years. The findings of this current analysis will be reported in a new manuscript, drafted by the writing committee on behalf of the three research groups. All investigators listed in the original trials will serve as collaborative authors.


Original languageEnglish
Article number1090
Publication statusPublished - 2023

External IDs

PubMed 37234075



  • Bayesian analysis, intraoperative ventilation, Mechanical ventilation, PEEP, postoperative pulmonary complications, recruitment maneuvers