{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T06:36:53Z","timestamp":1776926213924,"version":"3.51.2"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Methods<\/jats:title>\n We systematically searched the PubMed, Embase, the Cochrane Library, and WANFANG databases (2000\u20132025) for randomized controlled trials (RCTs) comparing lung-protective ventilation (LPV) with conventional ventilation in craniotomy patients. The primary outcome was the incidence of overall postoperative pulmonary complications (PPCs). The secondary outcomes included intracranial pressure (ICP), pulmonary infection, atelectasis, oxygenation index, and lung compliance. All analyses were performed using Review Manager 5.2.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Seven RCTs involving 523 patients were included in the study. Compared to conventional ventilation, LPV significantly reduced the risk of overall PPCs (OR 0.30, 95% CI: 0.18\u20130.48,\n p<\/jats:italic>\n \u202f&lt;\u202f0.00001,\n I<\/jats:italic>\n 2<\/jats:sup>\n =\u202f0%), without increasing the optic nerve sheath diameter (ONSD)\u2014a surrogate measure for ICP either before dual opening (MD: -0.01, 95%CI: \u22120.04\u20130.02,\n p<\/jats:italic>\n \u202f=\u202f0.45,\n I<\/jats:italic>\n 2<\/jats:sup>\n \u202f=\u202f0%) or at the end of surgery (MD: \u22120.04, 95%CI: \u22120.10\u20130.02,\n p<\/jats:italic>\n \u202f=\u202f0.21,\n I<\/jats:italic>\n 2<\/jats:sup>\n \u202f=\u202f0%). LPV significantly improved lung compliance (MD: 1.81, 95%CI: 0.79\u20132.84,\n p<\/jats:italic>\n \u202f=\u202f0.0005,\n I<\/jats:italic>\n 2<\/jats:sup>\n \u202f=\u202f81%) and oxygenation (MD: 40.28\u202fmmHg, 95%CI: 24.93\u201356.03,\n p<\/jats:italic>\n \u202f&lt;\u202f0.00001,\n I<\/jats:italic>\n 2<\/jats:sup>\n \u202f=\u202f59%) at the end of surgery, while also decreasing the risk of postoperative pulmonary infection (OR: 0.36, 95%CI: 0.22\u20130.59,\n p<\/jats:italic>\n \u202f&lt;\u202f0.0001,\n I<\/jats:italic>\n 2<\/jats:sup>\n \u202f=\u202f12%) and atelectasis (OR: OR: 0.15, 95%CI: 0.08\u20130.30,\n p<\/jats:italic>\n \u202f&lt;\u202f0.00001,\n I<\/jats:italic>\n 2<\/jats:sup>\n \u202f=\u202f14%).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n This meta-analysis demonstrates that LPV effectively reduces PPCs (moderate-quality evidence) and does not elevate ICP (low- to moderate-quality evidence). Although conclusions regarding ICP are based on surrogate measures, further large-scale RCTs with standardized measures of invasive ICP and consistent definitions of PPCs and LPV are required to validate our findings.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1803798","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T05:37:38Z","timestamp":1776922658000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and safety of lung-protective ventilation in neurosurgery: a systematic review and meta-analysis of randomized controlled clinical trials"],"prefix":"10.3389","volume":"13","author":[{"given":"Yan","family":"Liu","sequence":"first","affiliation":[{"name":"Zhuhai People's Hospital","place":["Zhuhai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qian","family":"Cao","sequence":"additional","affiliation":[{"name":"Dazhou Dachuan District People's Hospital","place":["Dazhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qian-Yun","family":"Pang","sequence":"additional","affiliation":[{"name":"Chongqing University Cancer Hospital","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongliang","family":"Liu","sequence":"additional","affiliation":[{"name":"Zhuhai People's Hospital","place":["Zhuhai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"222","DOI":"10.3171\/JNS\/2008\/109\/8\/0222","article-title":"Incidence and risk factors for postoperative pulmonary complications in elective intracranial surgery","volume":"109","author":"Sogame","year":"2008","journal-title":"J Neurosurg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"898","DOI":"10.1016\/j.bja.2019.08.017","article-title":"Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations","volume":"123","author":"Young","year":"2019","journal-title":"Br J Anaesth"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1186\/s12871-021-01404-8","article-title":"Intraoperative protective ventilation in patients undergoing major neurosurgical interventions: a randomized clinical trial","volume":"21","author":"Longhini","year":"2021","journal-title":"BMC Anesthesiol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1249","DOI":"10.62713\/aic.3513","article-title":"Drive pressure-guided individualized positive end-expiratory pressure in traumatic brain injury surgery: a randomized controlled trial","volume":"95","author":"Chen","year":"2024","journal-title":"Ann Ital 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(VMCA)","volume":"35","author":"Ludwig","year":"2000","journal-title":"Anasthesiol Intensivmed Notfallmed Schmerzther"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1263","DOI":"10.1016\/j.jcrc.2015.07.019","article-title":"Effects of positive end-expiratory pressure on brain tissue oxygen pressure of severe traumatic brain injury patients with acute respiratory distress syndrome: A pilot study","volume":"30","author":"Nemer","year":"2015","journal-title":"J Crit Care"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1097\/01.TA.0000152806.19198.DB","article-title":"Effects of PEEP on the intracranial system of patients with head injury and subarachnoid hemorrhage: the role of respiratory system compliance","volume":"58","author":"Caricato","year":"2005","journal-title":"J Trauma"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1007\/s00701-024-06067-1","article-title":"Effect of different positive end expiratory pressure levels on optic nerve sheath diameter in patients with or without midline shift who are undergoing supratentorial craniotomy","volume":"166","author":"Fenerci","year":"2024","journal-title":"Acta Neurochir (Wien)"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e0196980","DOI":"10.1371\/journal.pone.0196980","article-title":"Impact of positive end expiratory pressure on cerebral hemodynamic in paediatric patients with posttraumatic brain swelling treated by surgical decompression","volume":"13","author":"De Rosa","year":"2018","journal-title":"PLoS One"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1097\/ANA.0b013e31828bac4d","article-title":"Effects of positive end expiratory pressure (PEEP) on intracranial and cerebral perfusion pressure in pediatric neurosurgical patients","volume":"25","author":"Pulitano","year":"2013","journal-title":"J Neurosurg 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