Table 5.
Perioperative strategies for reducing postoperative pulmonary complications grouped according to type of intervention
| Category of intervention | Included interventions | No of patients | No of RCTs |
|---|---|---|---|
| Incentive spirometry | Incentive spirometry ± deep breathing exercises | 1940 | 6 |
| Prophylactic supervised respiratory physiotherapy | Prophylactic inspiratory muscle training, deep breathing exercise, and mobility programmes, conducted daily under supervision of physiotherapist for ≥3 days, during immediate pre/postoperative period | 1345 | 12 |
| Drug therapies to improve pulmonary function | Inhaled β agonists, inhaled steroid, inhaled mucolytic, prophylactic postoperative antibiotics for respiratory infection, intraoperative magnesium infusion | 1032 | 8 |
| Intraoperative anaesthetic gas composition | High (80%) perioperative fractional inspired concentration of oxygen, nitrous oxide free intraoperative inspired gas mixture | 3595 | 4 |
| Intraoperative ventilation strategies | High PEEP intraoperatively, ventilation strategies targeted to high or low tidal volumes per unit body weight, intraoperative alveolar recruitment strategies, square wave inspiratory flow pattern ventilation | 2132 | 18 |
| Prophylactic non-invasive ventilation | Prophylactic postoperative non-invasive ventilation, continuous positive air pressure, high flow nasal cannula oxygen therapy | 1173 | 10 |
| Analgesia techniques | Thoracic epidural analgesia, patient controlled thoracic epidural analgesia, paravertebral nerve block, preoperative non-steroidal anti-inflammatory drugs, intrapleural local anaesthetic infusion, intrathecal opioid, intraoperative dexmedetomidine infusion | 3106 | 17 |
| Lifestyle modifications | Smoking cessation therapy | 571 | 4 |
| Enhanced recovery after surgery pathways | Protocolised enhanced recovery pathways | 519 | 5 |
| Perioperative fluid administration | Restrictive versus liberal perioperative fluid administration, goal directed haemodynamic therapies | 4740 | 23 |
| Miscellaneous | Spinal v general anaesthesia, inhalational v intravenous general anaesthesia, breathing system filter, comparison of neuromuscular blocking drugs, perioperative statin use, supraglottic airway v endotracheal intubation, perioperative systemic warming, endotracheal tube cuff design | 1786 | 10 |
PEEP=positive end expiratory pressure; RCT=randomised controlled trial.