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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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Learning Objectives:After successfully completing this activity, the learner will be able to do the following:
Faculty & Credentials:
Editor-in-Chief: James C. Eisenach, M.D., receives consulting fees from Aerial BioPharma LLC and Cubist Pharmaceuticals, Inc.
CME Editors: Leslie C. Jameson, M.D., receives honoraria from GE Medical International and Masimo Corporation. Dan J. Kopacz, M.D., has an equity position in SoloDex, LLC.
Authors: Ary Serpa Neto, M.D., M.Sc., Ph.D., Sabrine N. T. Hemmes, M.D., Carmen S. V. Barbas, M.D., Ph.D., Martin Beiderlinden, M.D., Michelle Biehl, M.D., Jan M. Binnekade, Ph.D., Jaume Canet, M.D., Ph.D., Ana Fernandez-Bustamante, M.D., Ph.D., Emmanuel Futier, M.D., Ph.D., Ognjen Gajic, M.D., Ph.D., Göran Hedenstierna, M.D., Ph.D., Markus W. Hollmann, M.D., Ph.D., Samir Jaber, M.D., Ph.D., Alf Kozian, M.D., Ph.D., Marc Licker, M.D., Wen-Qian Lin, M.D., Andrew D. Maslow, M.D., Stavros G. Memtsoudis, M.D., Ph.D., Dinis Reis Miranda, M.D., Pierre Moine, M.D., Thomas Ng, M.D., Domenico Paparella, M.D., Christian Putensen, M.D., Ph.D., Marco Ranieri, M.D., Ph.D., Federica Scavonetto, M.D., Thomas Schilling, M.D., Ph.D., D.E.A.A., Werner Schmid, M.D., Ph.D., Gabriele Selmo, M.D., Paolo Severgnini, M.D., Juraj Sprung, M.D., Ph.D., Sugantha Sundar, M.D., Daniel Talmor, M.D., M.P.H., Tanja Treschan, M.D., Carmen Unzueta, M.D., Ph.D., Toby N. Weingarten, M.D., Esther K. Wolthuis, M.D., Ph.D., Hermann Wrigge, M.D., Ph.D., Marcelo Gama de Abreu, M.D., Ph.D., Paolo Pelosi, M.D., F.E.R.S., and Marcus J. Schultz, M.D., Ph.D., have reported no financial relationships with commercial interests.
Authors: Matthias Eikermann, M.D., Ph.D., and Tobias Kurth, M.D., M.Sc., have reported no financial relationships with commercial interests.
ASA Staff: Kari L. Lee, Editorial Manager, has reported no financial relationships with commercial interests. Ginger Yarger, Editor, has an equity position in Merck & Co.
Resolutions of Conflicts of Interest
In accordance with the ACCME Standards for Commercial Support of CME, the American Society of Anesthesiologists has implemented mechanisms, prior to the planning and implementation of this Journal-based CME activity, to identify and resolve conflicts of interest for all individuals in a position to control content of this Journal-based CME activity.
The information provided at this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.
Core Competencies:Medical knowledge
Target Audience:ANESTHESIOLOGY Journal CME is intended for anesthesiologists. Researchers and other health care professionals with an interest in anesthesiology may also participate.
CME Credit: 1.00 AMA PRA Category 1 Credit™
The American Society of Anesthesiologists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The American Society of Anesthesiologists designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
1.00 Non-physician Credit Non-physicians may receive a Certificate of Completion stating that this activity was designated for 1.00 AMA PRA Category 1 Credit(s)™.
Activity Release Date: 03/17/2015 (All day) Activity Expiration Date: 03/16/2018 (All day)
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