Lung protective ventilation in XXXX undergoing major surgery: a systematic review incorporating a Bayesian approach.

@entity1 @entity55 @entity649 @entity891 @entity2489 @entity544 @entity943 @entity647
OBJECTIVE: @entity2489 ( @entity2489 ) has been validated in @entity1 with acute @entity649 . However, the effect of @entity2489 in @entity1 undergoing major surgery is controversial. The study aimed to explore the beneficial effect of @entity2489 on @entity1 undergoing a major operation by systematic review and meta-analysis. SETTING: Various levels of medical centres. @entity1 : @entity1 undergoing general anaesthesia. INTERVENTIONS: @entity2489 with low tidal volume. PRIMARY AND SECONDARY OUTCOME MEASURES: Study end points included @entity647 ( @entity647 ), @entity55 , @entity891 , mortality, length of stay (LOS) in intensive care unit (ICU) and hospital. METHODS: Databases including PubMed, Scopus, EBSCO and EMBASE were searched from inception to May 2015. Search strategies consisted of terms related to @entity2489 and anaesthesia. We reported OR for binary outcomes including @entity647 , mortality, @entity55 , @entity891 and other adverse outcomes. Weighted mean difference was reported for continuous outcomes such as LOS in the ICU and hospital, pH value, partial pressure of @entity544 , oxygenation and duration of mechanical ventilation (MV). MAIN RESULTS: A total of 22 citations were included in the systematic review and meta-analysis. @entity2489 had protective effect against the development of @entity647 as compared with the control group, with an OR of 0.41 (95% CI 0.19 to 0.87). @entity2489 tended to be beneficial with regard to the development of @entity55 (OR 0.46, 95% CI 0.16 to 1.28) and @entity891 (OR 0.68, 95% CI 0.46 to 1.01), but statistical significance was not reached. Other adverse outcomes such as new onset @entity943 were significantly reduced with the use of @entity2489 (OR 0.47, 95% CI 0.48 to 0.93). CONCLUSIONS: The study demonstrates that @entity2489 can reduce the risk of @entity647 in @entity1 undergoing major surgery. However, there is insufficient evidence that such a beneficial effect can be translated to more clinically relevant outcomes such as mortality or duration of MV. TRIAL REGISTRATION NUMBER: The study was registered in PROSPERO (http://www.crd.york.ac.uk/PROSPERO/) under registration number CRD42013006416.
