Effect of Driving Pressure-Oriented Ventilation on Patients Undergoing One-Lung Ventilation During Thoracic Surgery: A Systematic Review and Meta-Analysis

Xuan Li; Wenqiang Xue; Qinyu Zhang; Yuyang Zhu; Yu Fang; Jie Huang

doi:10.3389/fsurg.2022.914984

Effect of Driving Pressure-Oriented Ventilation on Patients Undergoing One-Lung Ventilation During Thoracic Surgery: A Systematic Review and Meta-Analysis

Front Surg. 2022 May 27:9:914984. doi: 10.3389/fsurg.2022.914984. eCollection 2022.

Authors

Xuan Li¹, Wenqiang Xue¹, Qinyu Zhang¹, Yuyang Zhu¹, Yu Fang¹, Jie Huang¹

Affiliation

¹ Department of Anesthesiology, The First Affiliated Hospital of Kunming Medical University, KunMing, China.

Abstract

Background: Hypoxemia and fluctuations in respiratory mechanics parameters are common during one-lung ventilation (OLV) in thoracic surgery. Additionally, the incidence of postoperative pulmonary complications (PPC_S) in thoracic surgery is higher than that in other surgeries. Previous studies have demonstrated that driving pressure-oriented ventilation can reduce both mortality in patients with acute respiratory distress syndrome (ARDS) and the incidence of PPC_S in patients undergoing general anesthesia. Our aim was to determine whether driving pressure-oriented ventilation improves intraoperative physiology and outcomes in patients undergoing thoracic surgery.

Methods: We searched MEDLINE via PubMed, Embase, Cochrane, Web of Science, and ClinicalTrials.gov and performed a meta-analysis to compare the effects of driving pressure-oriented ventilation with other ventilation strategies on patients undergoing OLV. The primary outcome was the PaO₂/FiO₂ ratio (P/F ratio) during OLV. The secondary outcomes were the incidence of PPC_S during follow-up, compliance of the respiratory system during OLV, and mean arterial pressure during OLV.

Results: This review included seven studies, with a total of 640 patients. The PaO₂/FiO₂ ratio was higher during OLV in the driving pressure-oriented ventilation group (mean difference [MD]: 44.96; 95% confidence interval [CI], 24.22-65.70.32; I ²: 58%; P < 0.0001). The incidence of PPC_S was lower (OR: 0.58; 95% CI, 0.34-0.99; I ²: 0%; P = 0.04) and the compliance of the respiratory system was higher (MD: 6.15; 95% CI, 3.97-8.32; I ²: 57%; P < 0.00001) in the driving pressure-oriented group during OLV. We did not find a significant difference in the mean arterial pressure between the two groups.

Conclusion: Driving pressure-oriented ventilation during OLV in patients undergoing thoracic surgery was associated with better perioperative oxygenation, fewer PPC_S, and improved compliance of the respiratory system.

Systematic review registration: PROSPERO, identifier: CRD42021297063.

Keywords: driving pressure; lung-protective ventilation; one-lung ventilation (OLV); oxygenation; postoperative pulmonary complications (PPCs).

Publication types

Review