Table 1 Study characteristics
Study | Study design | Surgery | Position | N total | TV (ml/kg) | PEEP (cmH2O) | RM | Mean age (years) | BMI (kg/m2) | n | ASA | Strategy classification | HD complications | RM | PPC events (include hypoxemia SpO2 < 90%) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Whalen FX et al. (2006) | single centre | laparoscopic bariatric Roux-en-Y surgeries | RT | 20 | 8 | 4 | no | 38 ± 11 | 53 ± 11 | 10 | II-III | LPEEP | NA | After PNP, PEEP increased in a stepwise fashion for 2 min— to 10 cm H2O(3 breaths), to 15 cm H2O(3 breaths), to 20 cm H2O(10 breaths) until PIP reached 50 cm H2O. RM were repeated if Pao2 showed an increasing trend after the 1st RM, a series of up to 4 sequential RM was performed | 2(1 - respiratory failure, 1 - atelectasis requiring bronchoscopy) |
8 | 12 | yes | 44 ± 9 | 48 ± 6 | 10 | HPEEP | 3 (1- pulmonary embolism, 2 - respiratory failure) | ||||||||
Stankiewicz-Rudnicki M et al.(2016) | single centre | laparoscopic gastric banding | RT | 49 | 8 | 0 | no | 38 (32,5–43,5) | 42.8 (40.8–46.9) | 24 | LPEEP | NA | Before mechanical ventilation was started a RM was performed (2 sustained inflations for 10 s, each with PIP of 40 cm H2O) | ||
8 | 10 | yes | 40 (31–47) | 41.7 (38.8–46.8) | 25 | HPEEP | |||||||||
Nestler C et al. (2017) | single centre | laparoscopic surgery | RT | 50 | 8 | 5 | no | 46.2 (19–63) | 53.8 (8.2) | 25 | I-III | MPEEP | 42% had BP complications, 20% had bradycardia | PIP 50 cm H2O, PEEP 30 cm H2O, respiratory rate 6 bpm, for 10 cycles | 0 |
8 | EIT | yes | 44.9 (23–62) | 48.3 (7.1) | 25 | IPEEP | 40% had BP complications, 28% had bradycardia | 2 (8%) - pneumonia or the need for invasive or non-invasive ventilation for acute respiratory failure | |||||||
Wei K et al. (2018) | single centre | laparoscopic sleeve gastrectomy | RT | 34 | 8 | 0 | no | 37 (19–57) | 45 ± 6 | 12 | II-III | LPEEP | 1 patient was excluded for persistent hypotension | After PNP and repeated every 30 min: increasing PEEP in a stepwise fashion- to 5 cmH2O, to 10 cmH2O, and then to 15 cmH2O with 3 breaths on each point. If PIP > 40cmH2O, the next level of PEEP was halted. If MAP decreased by > 25% of baseline value, the RM was stopped | 1 (8%) − 1patient with postop resp failure requiring oxygen therapy |
8 | 0 | yes | 35 (18–46) | 48 ± 8 | 11 | LPEEP | 0 | ||||||||
8 | 8 | yes | 39 (21–50) | 43 ± 6 | 11 | HPEEP | 0 | ||||||||
Van Hecke D et al. (2019) | single centre | laparoscopic bariatric surgery | RT | 100 | 8 | 10 | yes | 40 (27–47) | 42 (39–45) | 50 | II-III | HPEEP | NA | RM were applied whenever the SpO2 < 95%, using to the protocol described by Whalen et al.(2006) | 1.3% -hypoxemia time |
8 | Cdyn guided | no | 42 (31–48) | 42 (40–45) | 50 | IPEEP | 2.1% | ||||||||
Elshazly M et al. (2020) | single centre | laparoscopic bariatric surgery | RT | 40 | 6 | 4 | no | 35.6 (7.80) | 43.85 (3.76) | 20 | II | LPEEP | 1 patient from control group developed hypotension | 5 (25%) - hypoxia | |
6 | US-guided | no | 37.00 (4.71) | 43 (2.83) | 20 | IPEEP | 0 | ||||||||
Simon P et al.(2021) | single centre | 73 - gastric bypass, 16 - sleeve gastrectomy, 1- rectal cancer surgery | RT | 90 | 7–8 | EIT | yes | 44.9 ± 10.3 | 48.2 ± 7.0 | 25 | IPEEP | hypotension in 10 patients (40%), bradicardia 7 (28%) | I: E, 1:1;, 50 cm H2O; PEEP, 30 cm H2O; RR, 6 bpm | 2 (8%) | |
12 | yes | 43.6 ± 11.3 | 51.4 ± 13.4 | 21 | HPEEP | hypotension in 7 patients (33%), bradicardia − 10(48%) | I: E, 1:1;PEEP, 12 cm H2O; RR, 6 bpm; increasing VT in steps of 4 ml/kg of predicted body weight until Pplateau reaches 40 cm H2O followed by 3 breaths while maintaining Pplateau of 40–50 cmH2O | 1 (5%) | |||||||
4–5 | no | 46.5 ± 14.1 | 51.0 ± 9.5 | 44 | LPEEP | hypotension in 22 patients (50%), bradicardia 11(25%) | 2 (5%) | ||||||||
Li Xiang et al. (2023) | single centre | laparoscopic bariatric surgery | RT | 40 | 8 | 8 | yes | 27 ± 7 | 40.1 ± 3.5 | 20 | II-III | MPEEP | 8 (40%) hypotension during RM | PC ventilation mode, with a stepwise increase PEEP from 10 to 25 by 5 cm H2O every 30 s and a driving pressure of 15 cm H2O | 20% |
8 | Cdyn guided | yes | 28 ± 7 | 41.9 ± 5.6 | 20 | IPEEP | 6 (30) | 20% |