Volume 11,Issue 5
Effect of Individualized PEEP on Postoperative Pulmonary Complications in Elder Patients: A Meta-Analysis
Objective: To systematically evaluate the effect of individualized positive end-expiratory pressure (PEEP) during endotracheal general anesthesia on postoperative pulmonary complications (PPCs) in older surgical patients. Methods: Randomized controlled trials (RCTs) published from database inception to April 2026 were retrieved from PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang, and VIP. Meta-analysis was performed using RevMan 5.4 and Stata 17.0. Results: Fourteen studies involving 1, 028 patients (individualized PEEP group: n = 515; control group: n = 513) were included. Compared to controls, the individualized PEEP group significantly reduced PPC incidence (RR = 0.50, 95% CI 0.40 to 0.62, P < 0.01), lower postoperative lung ultrasound scores (LUS) (MD = –2.76, 95% CI –3.27 to –2.25, P < 0.01), reduced intraoperative driving pressure (MD = –3.29 mmHg, 95% CI –3.74 to –2.84, P < 0.01), shorter hospitalization duration (MD = –0.36 d, 95% CI –0.57 to –0.14, P < 0.01), improved intraoperative oxygenation index (OI) (MD = 37.44, 95% CI 25.40 to 49.47, P < 0.01), higher pulmonary compliance (MD = 5.32, 95% CI 4.59 to 6.06, P < 0.01) and no significant difference in mean arterial pressure (MAP) was observed. Conclusion: Individualized PEEP titration during general anesthesia in elderly patients improves intraoperative oxygenation and respiratory mechanics without compromising hemodynamic stability. This strategy reduces the incidence of PPCs, shortens hospital stays, and enhances clinical outcomes.
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