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Mazzinari G, Zampieri FG, Ball L, Campos NS, Bluth T, Hemmes SN, Ferrando C, Librero J, Soro M, Pelosi P, Gama de Abreu M, Schultz MJ, Serpa Neto A. Effect of intraoperative PEEP with recruitment maneuvers on the occurrence of postoperative pulmonary complications during general anesthesia--protocol for Bayesian analysis of three randomized clinical trials of intraoperative ventilation. F1000Res 2023; 11:1090. [PMID: 37234075 PMCID: PMC10207960 DOI: 10.12688/f1000research.125861.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 10/22/2023] Open
Abstract
Background: Using the frequentist approach, a recent meta-analysis of three randomized clinical trials in patients undergoing intraoperative ventilation during general anesthesia for major surgery failed to show the benefit of ventilation that uses high positive end-expiratory pressure with recruitment maneuvers when compared to ventilation that uses low positive end-expiratory pressure without recruitment maneuvers. Methods: We designed a protocol for a Bayesian analysis using the pooled dataset. The multilevel Bayesian logistic model will use the individual patient data. Prior distributions will be prespecified to represent a varying level of skepticism for the effect estimate. The primary endpoint will be a composite of postoperative pulmonary complications (PPC) within the first seven postoperative days, which reflects the primary endpoint of the original studies. We preset a range of practical equivalence to assess the futility of the intervention with an interval of odds ratio (OR) between 0.9 and 1.1 and assess how much of the 95% of highest density interval (HDI) falls between the region of practical equivalence. Ethics and dissemination: The used data derive from approved studies that were published in recent years. The findings of this current analysis will be reported in a new manuscript, drafted by the writing committee on behalf of the three research groups. All investigators listed in the original trials will serve as collaborative authors.
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Affiliation(s)
- Guido Mazzinari
- Perioperative Medicine, Instituto de Investigación Sanitaria la Fe, Valencia, Spain, 46026, Spain
- Anesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain, 46026, Spain
| | | | - Lorenzo Ball
- Surgical sciences and integrated diagnostics, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| | - Niklas S. Campos
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Cardio pulmonary department, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidad de de Sao Paulo, Sao Paulo, Brazil
| | - Thomas Bluth
- Pulmonary Engineergin group, Anesthesiology and intensive Care, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Sabrine N.T. Hemmes
- Anesthesiology, Amsterdam University Medical Centers, location ‘AMC’, Amsterdam, The Netherlands
- Intensive Care, Amsterdam University Medical Centers, location ‘AMC’, Amsterdam, The Netherlands
| | - Carlos Ferrando
- Anesthesiology and Critical Care, Hospital Clinic de Barcelona, Institut D'investigació August Pi i Sunyer, Barcelona, Spain
- CIBER (Center of Biomedical Research in Respiratory Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Julian Librero
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain
| | - Marina Soro
- INCLIVA Clinical Research Institute, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Paolo Pelosi
- Surgical sciences and integrated diagnostics, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| | - Marcelo Gama de Abreu
- Pulmonary Engineergin group, Anesthesiology and intensive Care, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Marcus J. Schultz
- Intensive Care, Amsterdam University Medical Centers, location ‘AMC’, Amsterdam, The Netherlands
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of tropical medicine, Mahidol University, Bangkok, Thailand
| | - Ary Serpa Neto
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Cardio pulmonary department, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidad de de Sao Paulo, Sao Paulo, Brazil
- Intensive Care, Amsterdam University Medical Centers, location ‘AMC’, Amsterdam, The Netherlands
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia
- Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia
| | - PROVHILO investigators
- Perioperative Medicine, Instituto de Investigación Sanitaria la Fe, Valencia, Spain, 46026, Spain
- Anesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain, 46026, Spain
- Academic Research Organization, Albert Einstein Hospital, Sao Paulo, Brazil
- Surgical sciences and integrated diagnostics, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Cardio pulmonary department, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidad de de Sao Paulo, Sao Paulo, Brazil
- Pulmonary Engineergin group, Anesthesiology and intensive Care, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Anesthesiology, Amsterdam University Medical Centers, location ‘AMC’, Amsterdam, The Netherlands
- Intensive Care, Amsterdam University Medical Centers, location ‘AMC’, Amsterdam, The Netherlands
- Anesthesiology and Critical Care, Hospital Clinic de Barcelona, Institut D'investigació August Pi i Sunyer, Barcelona, Spain
- CIBER (Center of Biomedical Research in Respiratory Diseases, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain
- INCLIVA Clinical Research Institute, Hospital Clinico Universitario de Valencia, Valencia, Spain
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of tropical medicine, Mahidol University, Bangkok, Thailand
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia
- Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia
| | - iPROVE investigators
- Perioperative Medicine, Instituto de Investigación Sanitaria la Fe, Valencia, Spain, 46026, Spain
- Anesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain, 46026, Spain
- Academic Research Organization, Albert Einstein Hospital, Sao Paulo, Brazil
- Surgical sciences and integrated diagnostics, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Cardio pulmonary department, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidad de de Sao Paulo, Sao Paulo, Brazil
- Pulmonary Engineergin group, Anesthesiology and intensive Care, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Anesthesiology, Amsterdam University Medical Centers, location ‘AMC’, Amsterdam, The Netherlands
- Intensive Care, Amsterdam University Medical Centers, location ‘AMC’, Amsterdam, The Netherlands
- Anesthesiology and Critical Care, Hospital Clinic de Barcelona, Institut D'investigació August Pi i Sunyer, Barcelona, Spain
- CIBER (Center of Biomedical Research in Respiratory Diseases, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain
- INCLIVA Clinical Research Institute, Hospital Clinico Universitario de Valencia, Valencia, Spain
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of tropical medicine, Mahidol University, Bangkok, Thailand
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia
- Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia
| | - PROBESE investigators
- Perioperative Medicine, Instituto de Investigación Sanitaria la Fe, Valencia, Spain, 46026, Spain
- Anesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain, 46026, Spain
- Academic Research Organization, Albert Einstein Hospital, Sao Paulo, Brazil
- Surgical sciences and integrated diagnostics, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Cardio pulmonary department, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidad de de Sao Paulo, Sao Paulo, Brazil
- Pulmonary Engineergin group, Anesthesiology and intensive Care, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Anesthesiology, Amsterdam University Medical Centers, location ‘AMC’, Amsterdam, The Netherlands
- Intensive Care, Amsterdam University Medical Centers, location ‘AMC’, Amsterdam, The Netherlands
- Anesthesiology and Critical Care, Hospital Clinic de Barcelona, Institut D'investigació August Pi i Sunyer, Barcelona, Spain
- CIBER (Center of Biomedical Research in Respiratory Diseases, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain
- INCLIVA Clinical Research Institute, Hospital Clinico Universitario de Valencia, Valencia, Spain
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of tropical medicine, Mahidol University, Bangkok, Thailand
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia
- Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia
| | - PROVE network investigators
- Perioperative Medicine, Instituto de Investigación Sanitaria la Fe, Valencia, Spain, 46026, Spain
- Anesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain, 46026, Spain
- Academic Research Organization, Albert Einstein Hospital, Sao Paulo, Brazil
- Surgical sciences and integrated diagnostics, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Cardio pulmonary department, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidad de de Sao Paulo, Sao Paulo, Brazil
- Pulmonary Engineergin group, Anesthesiology and intensive Care, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Anesthesiology, Amsterdam University Medical Centers, location ‘AMC’, Amsterdam, The Netherlands
- Intensive Care, Amsterdam University Medical Centers, location ‘AMC’, Amsterdam, The Netherlands
- Anesthesiology and Critical Care, Hospital Clinic de Barcelona, Institut D'investigació August Pi i Sunyer, Barcelona, Spain
- CIBER (Center of Biomedical Research in Respiratory Diseases, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain
- INCLIVA Clinical Research Institute, Hospital Clinico Universitario de Valencia, Valencia, Spain
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of tropical medicine, Mahidol University, Bangkok, Thailand
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia
- Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia
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