Evidence map›Paper›PMID 26947624›Full record

SynthesisThe Lancet. Respiratory medicine2016

Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data.

Ary Serpa Neto, Sabrine N T Hemmes, Carmen S V Barbas, Martin Beiderlinden, Ana Fernandez-Bustamante, Emmanuel Futier, Ognjen Gajic, Mohamed R El-Tahan, Abdulmohsin A Al Ghamdi, Ersin Günay and 30 more

Erratum issued 11 registry-linked trialsOpen access · greenAbstract readMeta-AnalysisReview
PubMed Publisher
In one paragraph

Synthesis in The Lancet. Respiratory medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 11 registered trials, which are not on this map. Cited by 266 papers, 13 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
266citing papers in PubMed, 13 pooled it
45.6field-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.

NCT02798133 nacompletednot on this map

Open Lung Approach Versus Standard Protective Strategies: Effects on Driving Pressure and Ventilatory Efficiency During Anesthesia

TypeinterventionalSponsorFundación para la Investigación del Hospital Clínico de ValenciaRan2014 to 2014Enrolled36ConditionsLung CollapseArmsOLA, RM-5
NCT02989415 completednot on this mapstarted 2017, after this paper: background citation

Assessment of Ventilatory Management During General Anesthesia for Robotic Surgery and Its Effects on Postoperative Pulmonary Complications: A Prospective Observational Multicenter Study

TypeobservationalSponsorHospital Israelita Albert EinsteinRan2017 to 2020Enrolled1,015ConditionsRobotic Surgery, Mechanical VentilationArmsMechanical Ventilation
NCT03177564 naunknown statusnot on this mapstarted 2017, after this paper: background citation

A Randomized Controlled Trial to Assess the Feasiblity of a Driving Pressure Limited Ventilation vs.Standard Strategy During Video-assisted Thoracoscopic Lobectomy

TypeinterventionalSponsorThe Affiliated Hospital of Xuzhou Medical UniversityRan2017 to 2018Enrolled90ConditionsPulmonary Complication, Thoracic SurgeryArmsProtective ventilation 1, Protective ventilation 2, Driving Pressure Limited Ventilation
NCT03435913 nacompletednot on this mapstarted 2018, after this paper: background citation

Assessment of Transpulmonary Driving Pressure and Intra-abdominal Pressure Relationship at Different Levels of Positive End-expiratory Pressure (PEEP) During Laparoscopic Surgery

TypeinterventionalSponsorHospital Universitario La FeRan2018 to 2018Enrolled30ConditionsAnesthesia, General/Methods, Laparoscopy, Respiration, Artificial, Positive-Pressure RespirationArmsStandard PEEP ventilation, Matched PEEP ventilation
NCT03568786 nacompletednot on this map

Influence of the End-inspiratory Pause on Mechanical Ventilation and Its Correlation With Electrical Impedance Tomography

TypeinterventionalSponsorFundación Pública Andaluza para la gestión de la Investigación en SevillaRan2016 to 2018Enrolled32ConditionsAnesthesia, SurgeryArmsEnd-inspiratory pause 10%, End-inspiratory pause 30%
NCT03715647 completednot on this mapstarted 2017, after this paper: background citation

Correlation of the Driving Pressure With the Survival of Puerperae Under Mechanical Ventilation by Electrical Impedance Tomography

TypeobservationalSponsorAmazon UniversityRan2017 to 2018Enrolled30ConditionsPostpartum Period, Sepsis, Respiratory Distress Syndrome,Adult, HELLP SyndromeArmsSepsis, HELLP Syndrome, Respiratory Distress Syndrome Adult
NCT03976947 completednot on this mapstarted 2017, after this paper: background citation

Impact of Lung Recruitment Maneuvers on Driving Pressure in Cardiac Surgery (IMPREMO): Before - After Trial

TypeobservationalSponsorUniversity Hospital, CaenRan2017 to 2018Enrolled217ConditionsRespiration, Artificial, Lung Diseases, Atelectasis, Cardiac Surgical Procedures
NCT05550181 completednot on this mapstarted 2022, after this paper: background citation

Associations of Intraoperative Hypocapnia With Patient Demographics, Ventilation Characteristics and Outcomes--Statistical Analysis Plan for an Individual Patient Data Analysis of PROVHILO and PROBESE

TypeobservationalSponsorNMC Specialty HospitalRan2022 to 2023Enrolled2,793ConditionsMechanical Ventilation Complication, Surgery, Pulmonary Complication, Intraoperative ComplicationsArmsintraoperative mechanical ventilation with hypocapnia (etCO2 < 35 mm Hg)
NCT07464288 nanot yet recruitingnot on this mapstarted 2026, after this paper: background citation

The Effect of Different Depths of Neuromuscular Blockade, Assessed by Train of Four (TOF) Monitoring, On Driving Pressure and the Development of Postoperative Critical Respiratory Events in Abdominal Surgeries

TypeinterventionalSponsorAnkara City Hospital BilkentRan2026 to 2026Enrolled128ConditionsDriving Pressure, Neuromuscular Blockade Monitoring, Postoperative Respiratory ComplicationsArmsRocuronium
NCT07667907 not yet recruitingnot on this mapstarted 2026, after this paper: background citation

Comparison of the Effects of vNOTES and Laparoscopic Gynecological Surgery on Intraoperative Respiratory Mechanics and Hemodynamics: A Prospective Observational Cohort Study

TypeobservationalSponsorBursa Yuksek Ihtisas Training and Research HospitalRan2026 to 2027Enrolled30ConditionsRespiratory Mechanics, HemodynamicsArmsvNOTES (Vaginal Natural Orifice Transluminal Endoscopic Surgery, Laparoscopic Gynecological Surgery
NCT07728214 nanot yet recruitingnot on this mapstarted 2026, after this paper: background citation

Reminder-enhanced Incentive Spirometry Evaluation (RISE)

TypeinterventionalSponsorUniversity of Colorado, DenverRan2026 to 2029Enrolled88ConditionsHypoxemiaArmsAlarms ON
3 · Its place in the literature

Who cites it

266 citing papers in PubMed, 13 syntheses or guidelines pooled it, 600 citations in OpenAlex.

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

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

40 authors at 20 institutions in 10 countries.

Ary Serpa NetoDepartment of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; Program of Post-Graduation, Research and Innovation, Faculdade de Medicina do ABC, Santo André, Brazil; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil. Electronic address: aryserpa@terra.com.br.
Sabrine N T HemmesDepartment of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
Carmen S V BarbasDepartment of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Martin BeiderlindenDepartment of Anaesthesiology, Düsseldorf University Hospital, Düsseldorf, Germany; Department of Anaesthesiology, Marienhospital Osnabrück, Osnabrück, Germany.
Ana Fernandez-BustamanteDepartment of Anesthesiology, University of Colorado, Aurora, CO, USA.
Emmanuel FutierDepartment of Anesthesiology and Critical Care Medicine, Estaing University Hospital, Clermont-Ferrand, France.
Ognjen GajicDivision of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
Mohamed R El-TahanDepartment of Cardiothoracic Anaesthesia & Surgical Intensive Care, King Fahd Hospital, University of Dammam, Dammam, Saudi Arabia.
Abdulmohsin A Al GhamdiDepartment of Anesthesiology, King Fahd Hospital, University of Dammam, Dammam, Saudi Arabia.
Ersin GünayDepartment of Chest Diseases, Research Unit INSERM U1046, Montpellier, France.
Samir JaberDepartment of Critical Care Medicine and Anesthesiology, Saint Eloi University Hospital, Research Unit INSERM U1046, Montpellier, France.
Serdar KokuluDepartment of Anaesthesiology and Reanimation, Research Unit INSERM U1046, Montpellier, France.
Alf KozianDepartment of Anesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.
Marc LickerDepartment of Anaesthesiology, Pharmacology and Intensive Care, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland.
Wen-Qian LinState Key Laboratory of Oncology of South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
Andrew D MaslowDepartment of Anesthesiology, The Warren Alpert School of Brown University, Providence, RI, USA.
Stavros G MemtsoudisDepartment of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA.
Dinis Reis MirandaDepartment of Intensive Care, Erasmus University Medical Center, Rotterdam, Netherlands.
Pierre MoineDepartment of Anesthesiology, University of Colorado, Aurora, CO, USA.
Thomas NgDepartment of Surgery, The Warren Alpert School of Brown University, Providence, RI, USA.
Domenico PaparellaDepartment of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy.
V Marco RanieriDepartment of Anesthesia and Intensive Care Medicine, Rome, Italy; Sapienza University of Rome, Rome, Italy; Policlinico Umberto I Hospital, Rome, Italy.
Federica ScavonettoDepartment of Anesthesiology and Anesthesia Clinical Research Unit, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
Thomas SchillingDepartment of Anesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.
Gabriele SelmoDepartment Biotechnology and Sciences of Life, Azienda Ospedaliera Fondazione Macchi, University of Insubria, Varese, Italy.
Paolo SevergniniDepartment Biotechnology and Sciences of Life, Azienda Ospedaliera Fondazione Macchi, University of Insubria, Varese, Italy.
Juraj SprungDepartment of Anesthesiology and Anesthesia Clinical Research Unit, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
Sugantha SundarDepartment of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Daniel TalmorDepartment of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Tanja TreschanDepartment of Anaesthesiology, Düsseldorf University Hospital, Heinrich-Heine University, Düsseldorf, Germany.
Carmen UnzuetaDepartment of Anaesthesiology, Hospital de Sant Pau, Barcelona, Spain.
Toby N WeingartenDepartment of Anesthesiology and Anesthesia Clinical Research Unit, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
Esther K WolthuisDepartment of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
Hermann WriggeDepartment of Anaesthesiology and Intensive Care Medicine, University of Hospital Leipzig, Leipzig, Germany.
Marcelo B P AmatoCardio-Pulmonary Department, Pulmonary Division, Heart Institute, University of São Paulo, São Paulo, Brazil.
Eduardo L V CostaCardio-Pulmonary Department, Pulmonary Division, Heart Institute, University of São Paulo, São Paulo, Brazil; Research and Education Institute, Hospital Sirio-Libanês, São Paulo, Brazil.
Marcelo Gama de AbreuPulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
Paolo PelosiDepartment of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino IST, University of Genoa, Genoa, Italy.
Marcus J SchultzDepartment of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
PROVE Network Investigators
Inserm · FRMayo Clinic in Arizona · USAcademic Medical Center · NLBrown University · USOtto-von-Guericke University Magdeburg · DEUniversidade de São Paulo · BRUniversity of Amsterdam · NLUniversity of Colorado Anschutz Medical Campus · USBeth Israel Deaconess Medical Center · USCentre Hospitalier Universitaire de Clermont-Ferrand · FRErasmus MC · NLHarvard University · USHeinrich Heine University Düsseldorf · DEHospital de Sant Pau · ESHospital for Special Surgery · USHospital Israelita Albert Einstein · BRImam Abdulrahman Bin Faisal University · SAIstituti di Ricovero e Cura a Carattere Scientifico · ITKing Fahd Hospital of the University · SAMarienhospital Osnabrück · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundProtective mechanical ventilation strategies using low tidal volume or high levels of positive end-expiratory pressure (PEEP) improve outcomes for patients who have had surgery. The role of the driving pressure, which is the difference between the plateau pressure and the level of positive end-expiratory pressure is not known. We investigated the association of tidal volume, the level of PEEP, and driving pressure during intraoperative ventilation with the development of postoperative pulmonary complications.

methodsWe did a meta-analysis of individual patient data from randomised controlled trials of protective ventilation during general anesthaesia for surgery published up to July 30, 2015. The main outcome was development of postoperative pulmonary complications (postoperative lung injury, pulmonary infection, or barotrauma).

findingsWe included data from 17 randomised controlled trials, including 2250 patients. Multivariate analysis suggested that driving pressure was associated with the development of postoperative pulmonary complications (odds ratio [OR] for one unit increase of driving pressure 1·16, 95% CI 1·13-1·19; p<0·0001), whereas we detected no association for tidal volume (1·05, 0·98-1·13; p=0·179). PEEP did not have a large enough effect in univariate analysis to warrant inclusion in the multivariate analysis. In a mediator analysis, driving pressure was the only significant mediator of the effects of protective ventilation on development of pulmonary complications (p=0·027). In two studies that compared low with high PEEP during low tidal volume ventilation, an increase in the level of PEEP that resulted in an increase in driving pressure was associated with more postoperative pulmonary complications (OR 3·11, 95% CI 1·39-6·96; p=0·006).

interpretationIn patients having surgery, intraoperative high driving pressure and changes in the level of PEEP that result in an increase of driving pressure are associated with more postoperative pulmonary complications. However, a randomised controlled trial comparing ventilation based on driving pressure with usual care is needed to confirm these findings.

fundingNone.

Indexed as

AdultAgedAnesthesia, GeneralFemaleHumansIntraoperative PeriodLung DiseasesMaleMiddle AgedPositive-Pressure RespirationPostoperative ComplicationsRandomized Controlled Trials as TopicTidal Volume

Identifiers

PMID26947624
OpenAlexW2291900475

What OpenQuestion holds

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Registered trials

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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.