Ary Serpa Neto1, Sabrine N T Hemmes2, Carmen S V Barbas3, Martin Beiderlinden4, Ana Fernandez-Bustamante5, Emmanuel Futier6, Markus W Hollmann7, Samir Jaber8, Alf Kozian9, Marc Licker10, Wen-Qian Lin11, Pierre Moine5, Federica Scavonetto12, Thomas Schilling9, Gabriele Selmo13, Paolo Severgnini14, Juraj Sprung12, Tanja Treschan15, Carmen Unzueta16, Toby N Weingarten12, Esther K Wolthuis7, Hermann Wrigge17, Marcelo Gama de Abreu18, Paolo Pelosi19, Marcus J Schultz20. 1. Department of Intensive Care, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Medical Intensive Care Unit, ABC Medical School (FMABC), Santo André, Brazil; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil. Electronic address: aryserpa@terra.com.br. 2. Department of Intensive Care, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Department of Anaesthesiology, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands. 3. Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil. 4. Department of Anaesthesiology, Düsseldorf University Hospital, Heinrich-Heine University, Düsseldorf, Germany; Department of Anaesthesiology, Marienhospital Osnabrück, Osnabrück, Germany. 5. Department of Anesthesiology, University of Colorado, Aurora, CO, USA. 6. Department of Aneasthesiology and Critical Care Medicine, Estaing University Hospital, Clermont-Ferrand, France. 7. Department of Intensive Care, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands. 8. Department of Critical Care Medicine and Anaesthesiology (SAR B), Saint Eloi University Hospital, Montpellier, France. 9. Department of Anaesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany. 10. Department of Anaesthesiology, Pharmacology and Intensive Care, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland. 11. State Key Laboratory of Oncology of South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China. 12. Department of Anesthesiology and Anesthesia Clinical Research Unit, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA. 13. Department of Anaesthesia, Azienda Ospedaliera Fondazione Macchi, Ospedale di Circolo, Varese, Italy. 14. Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy. 15. Department of Anaesthesiology, Düsseldorf University Hospital, Heinrich-Heine University, Düsseldorf, Germany. 16. Department of Anaesthesiology, Hospital de Sant Pau, Barcelona, Spain. 17. Department Anaesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany. 18. Department of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany. 19. Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino IST, University of Genoa, Genoa, Italy. 20. Department of Intensive Care, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Department of Anaesthesiology, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Laboratory of Experimental Intensive Care and Anaesthesiology, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands.
Abstract
BACKGROUND: Lung injury is a serious complication of surgery. We did a systematic review and meta-analysis to assess whether incidence, morbidity, and in-hospital mortality associated with postoperative lung injury are affected by type of surgery and whether outcomes are dependent on type of ventilation. METHODS: We searched MEDLINE, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials for observational studies and randomised controlled trials published up to April, 2014, comparing lung-protective mechanical ventilation with conventional mechanical ventilation during abdominal or thoracic surgery in adults. Individual patients' data were assessed. Attributable mortality was calculated by subtracting the in-hospital mortality of patients without postoperative lung injury from that of patients with postoperative lung injury. FINDINGS: We identified 12 investigations involving 3365 patients. The total incidence of postoperative lung injury was similar for abdominal and thoracic surgery (3·4% vs 4·3%, p=0·198). Patients who developed postoperative lung injury were older, had higher American Society of Anesthesiology scores and prevalence of sepsis or pneumonia, more frequently had received blood transfusions during surgery, and received ventilation with higher tidal volumes, lower positive end-expiratory pressure levels, or both, than patients who did not. Patients with postoperative lung injury spent longer in intensive care (8·0 [SD 12·4] vs 1·1 [3·7] days, p<0·0001) and hospital (20·9 [18·1] vs 14·7 [14·3] days, p<0·0001) and had higher in-hospital mortality (20·3% vs 1·4% p<0·0001) than those without injury. Overall attributable mortality for postoperative lung injury was 19% (95% CI 18-19), and differed significantly between abdominal and thoracic surgery patients (12·2%, 95% CI 12·0-12·6 vs 26·5%, 26·2-27·0, p=0·0008). The risk of in-hospital mortality was independent of ventilation strategy (adjusted HR 0·71, 95% CI 0·41-1·22). INTERPRETATION: Postoperative lung injury is associated with increases in in-hospital mortality and durations of stay in intensive care and hospital. Attributable mortality due to postoperative lung injury is higher after thoracic surgery than after abdominal surgery. Lung-protective mechanical ventilation strategies reduce incidence of postoperative lung injury but does not improve mortality. FUNDING: None.
BACKGROUND:Lung injury is a serious complication of surgery. We did a systematic review and meta-analysis to assess whether incidence, morbidity, and in-hospital mortality associated with postoperative lung injury are affected by type of surgery and whether outcomes are dependent on type of ventilation. METHODS: We searched MEDLINE, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials for observational studies and randomised controlled trials published up to April, 2014, comparing lung-protective mechanical ventilation with conventional mechanical ventilation during abdominal or thoracic surgery in adults. Individual patients' data were assessed. Attributable mortality was calculated by subtracting the in-hospital mortality of patients without postoperative lung injury from that of patients with postoperative lung injury. FINDINGS: We identified 12 investigations involving 3365 patients. The total incidence of postoperative lung injury was similar for abdominal and thoracic surgery (3·4% vs 4·3%, p=0·198). Patients who developed postoperative lung injury were older, had higher American Society of Anesthesiology scores and prevalence of sepsis or pneumonia, more frequently had received blood transfusions during surgery, and received ventilation with higher tidal volumes, lower positive end-expiratory pressure levels, or both, than patients who did not. Patients with postoperative lung injury spent longer in intensive care (8·0 [SD 12·4] vs 1·1 [3·7] days, p<0·0001) and hospital (20·9 [18·1] vs 14·7 [14·3] days, p<0·0001) and had higher in-hospital mortality (20·3% vs 1·4% p<0·0001) than those without injury. Overall attributable mortality for postoperative lung injury was 19% (95% CI 18-19), and differed significantly between abdominal and thoracic surgery patients (12·2%, 95% CI 12·0-12·6 vs 26·5%, 26·2-27·0, p=0·0008). The risk of in-hospital mortality was independent of ventilation strategy (adjusted HR 0·71, 95% CI 0·41-1·22). INTERPRETATION:Postoperative lung injury is associated with increases in in-hospital mortality and durations of stay in intensive care and hospital. Attributable mortality due to postoperative lung injury is higher after thoracic surgery than after abdominal surgery. Lung-protective mechanical ventilation strategies reduce incidence of postoperative lung injury but does not improve mortality. FUNDING: None.
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