SynthesisFrontiers in medicine2026
Driving pressure-guided ventilation during one-lung ventilation for thoracic surgery: a systematic review and meta-analysis.
Synthesis in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Authors and funding
2 authors.
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Abstract
Background: Driving pressure-guided ventilation has been proposed as a physiologically rational lung-protective strategy during one-lung ventilation for thoracic surgery. However, no previous systematic review has specifically focused on trials in which driving pressure was the explicit primary ventilatory target during one-lung ventilation. We aimed to assess the effects of driving pressure-guided ventilation on postoperative pulmonary complications (PPCs) and related perioperative outcomes in adults undergoing thoracic surgery. Methods: We searched MEDLINE, Embase, CENTRAL, Web of Science, Scopus, and trial registries from inception to 19 March 2026. We included randomized controlled trials comparing explicit driving pressure-guided ventilation with conventional non-driving-pressure-guided ventilation during one-lung ventilation in adults undergoing thoracic surgery. Observational studies were summarised narratively. Random-effects meta-analyses were performed using restricted maximum likelihood estimation with Hartung-Knapp adjustment. Certainty of evidence was assessed using GRADE. The review was registered in PROSPERO (CRD420261329253). Results: Four randomized controlled trials (654 patients) were included in the primary analysis. The pooled effect on PPCs was not statistically significant in the primary random-effects analysis (risk ratio [RR]: 0.60, 95% confidence interval [CI]: 0.26-1.35; Conclusion: The primary randomized evidence did not demonstrate a statistically significant reduction in postoperative pulmonary complications, and the overall certainty of evidence was low. The available data are therefore hypothesis-generating. Larger, multicentre, and geographically diverse randomized trials with harmonised outcome definitions are needed to clarify whether driving pressure-guided ventilation improves postoperative outcomes and should be adopted more broadly in thoracic anaesthesia. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261329253, Unique Identifier: CRD420261329253.
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