{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T12:32:47Z","timestamp":1777897967449,"version":"3.51.4"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>The influence of high positive end-expiratory pressure (PEEP) with recruitment maneuvers on the occurrence of postoperative pulmonary complications after surgery is still not definitively established. Bayesian analysis can help to gain further insights from the available data and provide a probabilistic framework that is easier to interpret. The objective was to estimate the posterior probability that the use of high PEEP with recruitment maneuvers is associated with reduced postoperative pulmonary complications in patients with intermediate-to-high risk under neutral, pessimistic, and optimistic expectations regarding the treatment effect.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Multilevel Bayesian logistic regression analysis was performed on individual patient data from three randomized clinical trials carried out on surgical patients at intermediate to high risk for postoperative pulmonary complications. The main outcome was the occurrence of postoperative pulmonary complications in the early postoperative period. This study examined the effect of high PEEP with recruitment maneuvers <jats:italic toggle=\"yes\">versus<\/jats:italic> low PEEP ventilation. Priors were chosen to reflect neutral, pessimistic, and optimistic expectations of the treatment effect.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Using a neutral, pessimistic, or optimistic prior, the posterior mean odds ratio for high PEEP with recruitment maneuvers compared to low PEEP was 0.85 (95% credible interval, 0.71 to 1.02), 0.87 (0.72 to 1.04), and 0.86 (0.71 to 1.02), respectively. Regardless of prior beliefs, the posterior probability of experiencing a beneficial effect exceeded 90%. Subgroup analysis indicated a more pronounced effect in patients who underwent laparoscopy (odds ratio, 0.67 [0.50 to 0.87]) and those at high risk for postoperative pulmonary complications (odds ratio, 0.80 [0.53 to 1.13]). Sensitivity analysis, considering severe postoperative pulmonary complications only or applying a different heterogeneity prior, yielded consistent results.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>High PEEP with recruitment maneuvers demonstrated a moderate reduction in the probability of postoperative pulmonary complication occurrence, with a high posterior probability of benefit observed consistently across various prior beliefs, particularly among patients who underwent laparoscopy.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/aln.0000000000005170","type":"journal-article","created":{"date-parts":[[2024,7,23]],"date-time":"2024-07-23T15:51:06Z","timestamp":1721749866000},"page":"72-97","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":19,"title":["High Positive End-expiratory Pressure (PEEP) with Recruitment Maneuvers versus Low PEEP during General Anesthesia for Surgery: A Bayesian Individual Patient Data Meta-analysis of Three Randomized Clinical Trials"],"prefix":"10.1097","volume":"142","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7377-331X","authenticated-orcid":false,"given":"Guido","family":"Mazzinari","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, La Fe Research Institute, Valencia, Spain; Perioperative Medicine Research Group, Valencia, Spain; and Department of Statistics and Operational Research, Universidad de Valencia, Valencia, Spain."}]},{"given":"Fernando G.","family":"Zampieri","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; and PROVE Network, Alberta Health Services, Edmonton, Alberta, Canada."}]},{"given":"Lorenzo","family":"Ball","sequence":"additional","affiliation":[{"name":"IRCCS San Martino Policlinico Hospital, Genoa, Italy; University of Genoa, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics, Genova, Italy; and Hospital Israelita Albert Einstein, S\u00e3o Paulo, Brazil."}]},{"given":"Niklas S.","family":"Campos","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Av Hospital Israelita Albert Einstein, S\u00e3o Paulo, Brazil; and Cardio-Pulmonary Department, Pulmonary Division, Heart Institute, Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil."}]},{"given":"Thomas","family":"Bluth","sequence":"additional","affiliation":[{"name":"Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany."}]},{"given":"Sabrine N. T.","family":"Hemmes","sequence":"additional","affiliation":[{"name":"Departments of Intensive Care and of Anesthesiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands."}]},{"given":"Carlos","family":"Ferrando","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Hospital Clinic de Barcelona, Research Institute August Pi i Sunyer, Barcelona, Spain; and Center of Biomedical Research in Respiratory Diseases, Health Institute Carlos III, Madrid, Spain."}]},{"given":"Julian","family":"Librero","sequence":"additional","affiliation":[{"name":"Navarrabiomed-Fundaci\u00f3n Miguel Servet, Red de Investigaci\u00f3n en Servicios de Salud en Enfermedades Cr\u00f3nicas (REDISSEC), Pamplona, Spain."}]},{"given":"Marina","family":"Soro","sequence":"additional","affiliation":[{"name":"INCLIVA Clinical Research Institute, Clinical Hospital, University of Valencia, Valencia, Spain."}]},{"given":"Paolo","family":"Pelosi","sequence":"additional","affiliation":[{"name":"IRCCS San Martino Policlinico Hospital, Genoa, Italy; and Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy."}]},{"given":"Marcelo","family":"Gama de Abreu","sequence":"additional","affiliation":[{"name":"Departments of Intensive Care and Resuscitation, of Cardiothoracic Anesthesia, and of Outcomes Research, Institute of Anesthesiology, Cleveland Clinic, Cleveland, Ohio."}]},{"given":"Marcus J.","family":"Schultz","sequence":"additional","affiliation":[{"name":"Department of Intensive Care and Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; and Department of Anesthesia, General Intensive Care and Pain Management, Division of Cardiothoracic and Vascular Anesthesia and Critical Care Medicine, Medical University Vienna, Wien, Austria."}]},{"given":"Ary","family":"Serpa Neto","sequence":"additional","affiliation":[{"name":"Ary Serpa Neto M.D., M.Sc., Ph.D.; Department of Critical Care Medicine and Cardio-Pulmonary Department, Pulmonary Division, S\u00e3o Paulo, Brasil; Department of Intensive Care, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia; and Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia."}]},{"name":"for REPEAT on behalf of the PROVHILO, iPROVE, and PROBESE investigators and the PROVE Network investigators","sequence":"additional","affiliation":[]}],"member":"276","published-online":{"date-parts":[[2024,7,22]]},"reference":[{"key":"R1-20250219","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1097\/EJA.0000000000000646","article-title":"Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS\u2013An observational study in 29 countries.","volume":"34","author":"Schultz","year":"2017","journal-title":"Eur J Anaesthesiol"},{"key":"R2-20250219","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1056\/NEJMoa1301082","article-title":"A trial of intraoperative low-tidal-volume ventilation in abdominal surgery.","volume":"369","author":"Futier","year":"2013","journal-title":"N Engl J Med"},{"key":"R3-20250219","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1097\/ALN.0000000000004009","article-title":"Perioperative pulmonary atelectasis: Part II. 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