Positive end‐expiratory pressure and postoperative complications in patients with obesity: a review and meta‐analysis. Issue 4 (28th February 2023)

• Record Type: Journal Article
• Authors: Choi, Jae Y.; Al‐Saedy, Miriam A.; Carlson, Brian
• Is Part Of: Obesity. Volume 31:Issue 4(2023)
• Page Start: 955
• Page End: 964
• Publication Date: 2023-02-28
• Subjects: Obesity -- Periodicals; 616.398005
• DOI: 10.1002/oby.23675
• Languages: English
• ISSNs: 1930-7381

Abstract

Abstract: Objective: In patients with obesity, use of positive end‐expiratory pressure (PEEP) > 5 cm H2 O (centimeters of water) has been shown to prevent intraoperative atelectasis. This study compares the rate of postoperative pulmonary complications (PPCs) associated with PEEP > 5 cm H2 O and PEEP ≤ 5 cm H2 O in patients with obesity who underwent surgery under general anesthesia with mechanical ventilation. Methods: This study searched Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) using the terms "PEEP, " "anesthesia, " and "ventilation." Cochrane ReviewManager (RevMan) version 5 was used for data analysis. The primary outcome was a composite of PPCs, including atelectasis, pneumonia, pneumothorax, and acute respiratory failure. Results: The initial search identified 903 titles and abstracts, and 4 randomized controlled trials were included for analysis. We included a total of 2116 participants from four randomized controlled trials that compared PEEP ≤ 5 cm H2 O with PEEP > 5 cm H2 O in adult patients with obesity. There was no statistically significant difference in PPCs between the PEEP ≤ 5 cm H2 O and PEEP > 5 cm H2 O groups (risk ratio = 2.21, 95% CI: 0.41‐11.83; p = 0.35). However, a significant heterogeneity was found within included studies ( I 2 = 53%). Conclusions: It is unclear whether PEEP > 5 cm H2 O improves the postoperative clinical outcome in patients with obesity, which is in contrast to previously established evidence that it reduces atelectasis in patients with obesity.