Journal CME - 2015 July
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Journal CME - 2015 July

Summary:

Background: Recent studies show that intraoperative mechanical ventilation using low tidal volumes (VT) can prevent postoperative pulmonary complications (PPCs). The aim of this individual patient data meta-analysis is to evaluate the individual associations between VT size and positive end–expiratory pressure (PEEP) level and occurrence of PPC.
Methods: Randomized controlled trials comparing protective ventilation (low VT with or without high levels of PEEP) and conventional ventilation (high VT with low PEEP) in patients undergoing general surgery. The primary outcome was development of PPC. Predefined prognostic factors were tested using multivariate logistic regression.
Results: Fifteen randomized controlled trials were included (2,127 patients). There were 97 cases of PPC in 1,118 patients (8.7%) assigned to protective ventilation and 148 cases in 1,009 patients (14.7%) assigned to conventional ventilation (adjusted relative risk, 0.64; 95% CI, 0.46 to 0.88; P < 0.01). There were 85 cases of PPC in 957 patients (8.9%) assigned to ventilation with low VT and high PEEP levels and 63 cases in 525 patients (12%) assigned to ventilation with low VT and low PEEP levels (adjusted relative risk, 0.93; 95% CI, 0.64 to 1.37; P = 0.72). A dose–response relationship was found between the appearance of PPC and VT size (R2 = 0.39) but not between the  appearance of PPC and PEEP level (R2 = 0.08).
Conclusions: These data support the beneficial effects of ventilation with use of low VT in patients undergoing surgery. Further trials are necessary to define the role of intraoperative higher PEEP to prevent PPC during nonopen abdominal surgery.

CME Credit: 1.00 AMA PRA Category 1 Credit™

Required Hardware / Software:
Adobe Acrobat Reader, Internet connection. Web browser version must have been released within the last three years.

Activity Release Date:
06/16/2015

Activity Expiration Date:
06/15/2018

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Item Details:

Learning Objectives:
After successfully completing this activity, the learner will be able to do the following:

  • Evaluate the quality of an individual patient data meta-analysis
  • Select the best ventilation volume (mL/predicted body weight) for an individual patient to avoid postoperative pulmonary...
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