High PEEP with recruitment maneuvers versus Low PEEP During General Anesthesia for Surgery -a Bayesian individual patient data meta-analysis of three randomized clinical trials

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • REPEATI on behalf of the PROVHILOII, iPROVEIII and PROBESEIV Investigators, and the PROVE Network investigators - (Author)
  • Department of Anesthesiology and Intensive Care Medicine
  • Center for Evidence-Based Healthcare
  • Ethics committee of TU Dresden
  • Hospital Universitario La Fe
  • University of Valencia
  • University of Alberta
  • IRCCS San Martino Polyclinic Hospital
  • University of Genoa
  • Hospital Israelita Albert Einstein
  • Universidade de São Paulo
  • University Hospital Carl Gustav Carus Dresden
  • Amsterdam University Medical Centers (UMC)
  • Hospital Clinic of Barcelona
  • CIBER - Center for Biomedical Research Network
  • Navarrabiomed
  • Hospital Clinico Universitario de Valencia
  • Cleveland Clinic Ohio
  • Mahidol Oxford Tropical Medicine Research Unit (MORU)
  • Medical University of Vienna
  • Monash University
  • University of Melbourne

Abstract

Background: The influence of high positive end-expiratory pressure (PEEP) with recruitment maneuvers on the occurrence of postoperative pulmonary complications after surgery is still not definitively established. Bayesian analysis can help to gain further insights from the available data and provide a probabilistic framework that is easier to interpret. Our objective was to estimate the posterior probability that the use of high PEEP with recruitment maneuvers is associated with reduced postoperative pulmonary complications in patients with intermediate-to-high risk under neutral, pessimistic, and optimistic expectations regarding the treatment effect. Methods: Multilevel Bayesian logistic regression analysis on individual patient data from three randomized clinical trials carried out on surgical patients at Intermediate-to-High Risk for postoperative pulmonary complications. The main outcome was the occurrence of postoperative pulmonary complications in the early postoperative period. We studied the effect of high PEEP with recruitment maneuvers versus Low PEEP Ventilation. Priors were chosen to reflect neutral, pessimistic, and optimistic expectations of the treatment effect. Results: Using a neutral, pessimistic, or optimistic prior, the posterior mean odds ratio (OR) for High PEEP with recruitment maneuvers compared to Low PEEP was 0.85 (95% Credible Interval [CrI] 0.71 to 1.02), 0.87 (0.72 to 1.04), and 0.86 (0.71 to 1.02), respectively. Regardless of prior beliefs, the posterior probability of experiencing a beneficial effect exceeded 90%. Subgroup analysis indicated a more pronounced effect in patients who underwent laparoscopy (OR: 0.67 [0.50 to 0.87]) and those at high risk for PPCs (OR: 0.80 [0.53 to 1.13]). Sensitivity analysis, considering severe postoperative pulmonary complications only or applying a different heterogeneity prior, yielded consistent results. Conclusion: High PEEP with recruitment maneuvers demonstrated a moderate reduction in the probability of PPC occurrence, with a high posterior probability of benefit observed consistently across various prior beliefs, particularly among patients who underwent laparoscopy.

Details

Original languageEnglish
Article number10.1097/ALN.0000000000005170
JournalAnesthesiology
Publication statusPublished - Oct 2024
Peer-reviewedYes

External IDs

ORCID /0000-0002-5385-9607/work/171553290
ORCID /0000-0003-3953-3253/work/171553834
ORCID /0000-0003-4397-1467/work/171554028

Keywords

ASJC Scopus subject areas