Evidence map›Paper›PMID 40133080›Full record

SynthesisAnaesthesia2025

Intra-operative ventilation strategies and their impact on clinical outcomes: a systematic review and network meta-analysis of randomised trials.

Naheed K Jivraj, Ines Lakbar, Behnam Sadeghirad, Mattia M Müller, Sei Yon Sohn, John K Peel, Arzina Jaffer, Vorakamol Phoophiboon, Vatsal Trivedi, Dipayan Chaudhuri and 5 more

Abstract readNetwork Meta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Anaesthesia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed.

  1. Trial
  2. Article
  3. Article
  4. Article
  5. Article
  6. Article
  7. Bayesian statistics: a primer for perioperative medicine clinicians.Perioperative medicine (London, England) · 2026
    Article
  8. Article
  9. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Naheed K JivrajDepartment of Anesthesiology and Pain Medicine and Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.ORCID https://orcid.org/0000-0002-4005-7015
Ines LakbarAnesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, Montpellier, France.
Behnam SadeghiradDepartment of Anesthesia and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Mattia M MüllerInstitute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
Sei Yon SohnDepartment of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA.
John K PeelDepartment of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
Arzina JafferCumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Vorakamol PhoophiboonDivision of Critical Care Medicine, Unity Health Toronto - St. Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada.
Vatsal TrivediInstitute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.
Dipayan ChaudhuriDivision of Critical Care, Intensive Care Unit, Department of Medicine, McMaster University, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
Cong LuKeenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.
Yunting LiuDepartment of Laboratory Medicine and Pathobiology, University of Toronto, ON, Canada.
Benedetta GiammarioliDivision of Critical Care Medicine, Unity Health Toronto - St. Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada.
Sharon EinavMaccabi Healthcare Services Sharon Region, Hebrew University Faculty of Medicine and Medint Medical Intelligence, Jerusalem, Israel.
Karen E A BurnsInterdepartmental Division of Critical Care Medicine, Temerty School of Medicine, University of Toronto, Toronto, ON, Canada.

Funding

Physicians' Services Incorporated Foundation #23-26
6 · The paper itself

Abstract

introductionPostoperative pulmonary complications are common and associated with significant morbidity and mortality; however, the optimal intra-operative ventilation strategy to prevent postoperative pulmonary complications remains unclear. The aim of this study was to evaluate the effect of intra-operative ventilation strategy, including tidal volumes, positive end-expiratory pressure (PEEP) and use of recruitment manoeuvres on the incidence of postoperative pulmonary complications in adults having non-cardiothoracic surgery.

methodsRelevant databases were searched to identify randomised controlled trials that directly compared intra-operative ventilation strategies among surgical patients who were followed up for > 24 hours postoperatively and reported at least one outcome of interest.

resultsA total of 51 randomised controlled trials were included. Compared with a high tidal volume/zero PEEP strategy, low tidal volume strategies likely reduced the risk of postoperative pulmonary complications when combined with: high PEEP (risk ratio (RR) 0.44, 95%CI 0.22-0.87); high PEEP with recruitment manoeuvres (RR 0.60, 95%CI 0.49-0.75); personalised PEEP with recruitment manoeuvres (RR 0.53, 95%CI 0.42-0.69); low PEEP (RR 0.63, 95%CI 0.50-0.78); and low PEEP with recruitment manoeuvres (RR 0.65, 95%CI 0.46-0.93) (all moderate certainty evidence). Compared with a low tidal volume/low PEEP strategy, a low tidal volume strategy with personalised PEEP likely reduces the risk of postoperative pulmonary complications (RR 0.85, 95%CI 0.73-0.99, moderate certainty). DISCUSSION: Among patients undergoing non-cardiothoracic surgery, the use of intra-operative low tidal volume ventilation with a range of acceptable PEEP levels likely reduced the risk of postoperative pulmonary complications compared with high tidal volumes and zero PEEP. This study highlights the need for implementation research at both the provider and system levels to improve intra-operative adherence to lung protective ventilation strategies.

Indexed as

Intraoperative CareLung DiseasesPostoperative ComplicationsRespiration, ArtificialHumansPositive-Pressure RespirationRandomized Controlled Trials as TopicTidal VolumeTreatment Outcomeintra‐operativelung protective ventilationmechanical ventilationpostoperative pulmonary complications

Identifiers

PMID40133080
PMCPMC12256175

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.