Evidence map›Paper›PMID 26174419›Full record

Observational studyBMJ (Clinical research ed.)2015

Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications: hospital based registry study.

Karim Ladha, Marcos F Vidal Melo, Duncan J McLean, Jonathan P Wanderer, Stephanie D Grabitz, Tobias Kurth, Matthias Eikermann

5 registry-linked trialsOpen access · bronzeAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ (Clinical research ed.), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 5 registered trials, which are not on this map. Cited by 153 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
153citing papers in PubMed, 6 pooled it
25.1field-weighted citation impact, top 1% of its field
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.

NCT03198208 unknown statusnot on this map

Effects of Intraoperative Fentanyl Dose on Postoperative Respiratory Complications

Typeobservational_patient_registrySponsorMassachusetts General HospitalRan2007 to 2018Enrolled183,396ConditionsFentanyl, Opioid Use, Surgery, Respiratory ComplicationArmsFentanyl dose administration
NCT04024410 completednot on this mapstarted 2019, after this paper: background citation

Optimal Positive End-expiratory Pressure (PEEP) in Prone Position During Spine Surgery. A Prospective Observational Study

TypeobservationalSponsorParc de Salut MarRan2019 to 2021Enrolled20ConditionsAnesthesia, SurgeryArmsEvaluation of PEEP in prone position
NCT04108130 nacompletednot on this mapstarted 2020, after this paper: background citation

An Anesthesia-Centered Bundle to Reduce Postoperative Pulmonary Complications: The PRIME-AIR Study

TypeinterventionalSponsorColumbia UniversityRan2020 to 2023Enrolled794ConditionsPostoperative Pulmonary ComplicationsArmsPreoperative Education, Intraoperative PEEP (Positive End-Expiratory Pressure) Individualization, Individualization of Neuromuscular Blockade, Postoperative Incentive Spirometry, Postoperative Ambulation
NCT05514366 nacompletednot on this mapstarted 2023, after this paper: background citation

Influence of Inspiratory Pause on Ventilatory Efficiency and Tidal Volume Distribution in Patients Undergoing Robotic Prostate Surgery and Ventilated With an Individualized Open Lung Approach. A Prospective Paired Study.

TypeinterventionalSponsorFundación Pública Andaluza para la gestión de la Investigación en SevillaRan2023 to 2023Enrolled18ConditionsMechanical Ventilation, Positive End-Expiratory Pressure, AnesthesiaArmsModifying EIP under a tOLA before pneumoperitoneum, Modifying EIP under a tOLA with pneumoperitoneum, Atelectasis test
NCT07431242 not yet recruitingnot on this mapstarted 2026, after this paper: background citation

Time-Dependent Exposure to Intraoperative Mechanical Power and Driving Pressure and Postoperative Pulmonary Outcomes in Laparoscopic Surgery

TypeobservationalSponsorIstinye UniversityRan2026 to 2026Enrolled90ConditionsPostoperative Pulmonary ComplicationsArmsIntraoperative Ventilatory Load Exposure (Mechanical Power and Driving Pressure)
3 · Its place in the literature

Who cites it

153 citing papers in PubMed, 6 syntheses or guidelines pooled it, 338 citations in OpenAlex.

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93 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 3 countries.

Karim LadhaDepartment of Anesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
Marcos F Vidal MeloDepartment of Anesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
Duncan J McLeanDepartment of Anesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
Jonathan P WandererDepartment of Anesthesiology, Vanderbilt University, Nashville, TN, USA.
Stephanie D GrabitzDepartment of Anesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
Tobias KurthINSERM Research Center for Epidemiology and Biostatistics (U897)-Team Neuroepidemiology, Bordeaux, France College of Health Sciences, University of Bordeaux, Bordeaux, France Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Matthias EikermannDepartment of Anesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA Essen-Duisburg University, Essen, Germany meikermann@partners.org.
Massachusetts General Hospital · USInserm · FRVanderbilt University · US

Funding

Regional Tidal Lung Strain and Neutrophilic Inflammation in Early Lung InjuryR01HL121228 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI VIDAL MELO, MARCOS F · 2014 to 2023
$6.2M
NHLBI NIH HHS 1R01HL121228-01NHLBI NIH HHS R01 HL121228
6 · The paper itself

Abstract

objectiveTo evaluate the effects of intraoperative protective ventilation on major postoperative respiratory complications and to define safe intraoperative mechanical ventilator settings that do not translate into an increased risk of postoperative respiratory complications.

designHospital based registry study.

settingAcademic tertiary care hospital and two affiliated community hospitals in Massachusetts, United States.

participants69,265 consecutively enrolled patients over the age of 18 who underwent a non-cardiac surgical procedure between January 2007 and August 2014 and required general anesthesia with endotracheal intubation.

interventionsProtective ventilation, defined as a median positive end expiratory pressure (PEEP) of 5 cmH2O or more, a median tidal volume of less than 10 mL/kg of predicted body weight, and a median plateau pressure of less than 30 cmH2O.

main outcome measureComposite outcome of major respiratory complications, including pulmonary edema, respiratory failure, pneumonia, and re-intubation.

resultsOf the 69,265 enrolled patients 34,800 (50.2%) received protective ventilation and 34,465 (49.8%) received non-protective ventilation intraoperatively. Protective ventilation was associated with a decreased risk of postoperative respiratory complications in multivariable regression (adjusted odds ratio 0.90, 95% confidence interval 0.82 to 0.98, P=0.013). The results were similar in the propensity score matched cohort (odds ratio 0.89, 95% confidence interval 0.83 to 0.97, P=0.004). A PEEP of 5 cmH2O and median plateau pressures of 16 cmH2O or less were associated with the lowest risk of postoperative respiratory complications.

conclusionsIntraoperative protective ventilation was associated with a decreased risk of postoperative respiratory complications. A PEEP of 5 cmH2O and a plateau pressure of 16 cmH2O or less were identified as protective mechanical ventilator settings. These findings suggest that protective thresholds differ for intraoperative ventilation in patients with normal lungs compared with those used for patients with acute lung injury.

Indexed as

Continuous Positive Airway PressurePositive-Pressure RespirationAnesthesia, GeneralClinical ProtocolsHumansLength of StayMassachusettsRegistriesRespiratory Distress SyndromeRisk FactorsTidal VolumeTime Factors

Identifiers

PMID26174419
PMCPMC4501577
OpenAlexW2151898076

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

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 OpenQuestion graph.