Intraoperative mechanical ventilation strategies for obese patients: a systematic review and network meta‐analysis

Summary Several intraoperative ventilation strategies are available for obese patients. However, the same ventilation interventions have exhibited different effects on PaO 2 / FIO 2 concerning obese patients in different trials, and the issue remains controversial. Therefore, we conducted a network meta‐analysis to identify the optimal mechanical ventilation strategy. We searched the Cochrane Central Register of Controlled Trials ( CENTRAL ) in the Cochrane Library, E mbase, MEDLINE , CINAHL and Web of Science for studies published up to J une 2014, and the PaO 2 / FIO 2 in obese patients given different mechanical ventilation strategies was assessed. We assessed the studies for eligibility and extracted data and then pooled the data and used a B ayesian fixed‐effect model to combine direct comparisons with indirect evidence. Eligible studies evaluated different ventilation strategies for obese patients and reported the intraoperative PaO 2 / FIO 2 ratio, atelectasis and pulmonary compliance. Thirteen randomized controlled trials were included for network meta‐analysis, including 476 patients who received 1 of 12 ventilation strategies. Volume‐controlled ventilation with higher PEEP plus single recruitment manoeuvres ( VCV + higher PEEP + single RM ) was associated with the highest PaO 2 / FiO 2 ratio, improving intraoperative pulmonary compliance and reducing the incidence of intraoperative atelectasis.